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Contemporary Multimodality Imaging of Primary Hyperparathyroidism.

Mitesh Naik1, Sairah R Khan1, Desmond Owusu1

  • 1From the Department of Radiology (M.N., S.R.K., A.A., J.E.J., C.J.H., T.D.B.) and Department of Endocrine and Thyroid Surgery (F.P.), Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, England; Department of Radiology, Dartford and Gravesham NHS Trust, Kent, England (D.O.); and Department of Surgery and Cancer, Imperial College London, London, England (T.D.B.).

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Summary

Primary hyperparathyroidism (PHPT) is diagnosed through clinical and biochemical tests. Imaging techniques like ultrasound and CT are crucial for localizing parathyroid adenomas before curative surgery.

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Area of Science:

  • Endocrinology
  • Radiology
  • Surgical Oncology

Background:

  • Primary hyperparathyroidism (PHPT) presents with hypercalcemia and elevated parathyroid hormone, often asymptomatic or with subtle neurocognitive changes.
  • Solitary adenomas are the most common cause, though multigland disease occurs.
  • Parathyroidectomy offers a cure for PHPT.

Purpose of the Study:

  • To review imaging modalities for localizing parathyroid adenomas in PHPT.
  • To discuss the advantages and disadvantages of various localization techniques.
  • To guide the selection of imaging strategies based on clinical scenarios.

Main Methods:

  • Review of ultrasound (US), parathyroid scintigraphy, and 4D-CT for adenoma localization.
  • Discussion of second- and third-line modalities including MRI, PET/CT, and selective venous sampling.
  • Analysis of technical aspects, benefits, and limitations of each imaging technique.

Main Results:

  • Imaging is essential for guiding minimally invasive parathyroidectomy.
  • US, scintigraphy, and 4D-CT are frequently used first-line localization techniques.
  • Multimodality imaging approaches are valuable for complex cases like ectopic or recurrent PHPT.

Conclusions:

  • Accurate localization of parathyroid adenomas is key to successful surgical outcomes in PHPT.
  • The choice of imaging modality depends on local expertise, patient factors, and surgeon preference.
  • A comprehensive, multimodality imaging strategy is recommended for challenging PHPT cases.