Contemporary Multimodality Imaging of Primary Hyperparathyroidism.

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.