Hyperparathyroidism: comparison of MR imaging with radionuclide scanning

Twenty-three patients with hyperparathyroidism were evaluated preoperatively with magnetic resonance (MR) imaging. Twenty patients also underwent thallium-201/technetium-99m scintigraphy. Of 22 patients with primary hyperparathyroidism, 12 had persistent or recurrent disease. One had secondary hyperparathyroidism due to end-stage renal disease. MR imaging allowed accurate localization of abnormal parathyroid glands in 64% evaluated prospectively and 82% evaluated retrospectively. Scintigraphy allowed localization of 60% evaluated prospectively and 70% retrospectively. The two imaging modalities together allowed detection of 68% evaluated prospectively and 91% retrospectively. MR imaging allowed detection of two of five mediastinal adenomas evaluated prospectively and four of five retrospectively. In patients who underwent both imaging studies, MR was more successful in those with previous neck surgery (73% evaluated prospectively and 91% retrospectively) than in those with no prior surgery (57% prospectively and 71% retrospectively). Scintigraphy allowed accurate localization in 64% evaluated prospectively and 64% retrospectively in patients with previous surgery versus 57% prospectively and 86% retrospectively in patients with no prior neck surgery. Four false-positive results were obtained with MR imaging and three with scintigraphy. MR imaging was useful for parathyroid localization in patients with hyperparathyroidism, particularly in patients requiring additional surgery.