Molecular Imaging in Parathyroid Carcinoma Management: A Comprehensive Review.

Area of Science:

• Endocrinology
• Oncology
• Radiology

Background:

• Parathyroid carcinoma (PC) is a rare endocrine malignancy, often presenting with severe hypercalcemia and high parathyroid hormone (PTH) levels.
• Distinguishing PC from benign parathyroid disease on imaging is challenging, necessitating precise diagnostic tools.

Purpose of the Study:

• To review and evaluate current and emerging imaging modalities for parathyroid carcinoma diagnosis.
• To provide guidance on the clinical application of various imaging techniques for PC.

Main Methods:

• Cervical ultrasonography (US) with advanced detective flow imaging for anatomical and vascular assessment.
• Nuclear medicine techniques including [99mTc]Tc-MIBI scintigraphy, [18F]fluorocholine PET/CT, and [18F]FDG PET.
• Evaluation of novel radiotracers ([18F]FAPI, [68Ga]Ga-trivehexin) and theranostic approaches.

Main Results:

• Multimodal imaging combining US and nuclear medicine offers high sensitivity for PC detection.
• [18F]fluorocholine PET/CT and PET/MR demonstrate superior performance in identifying primary and metastatic PC.
• Emerging tracers and theranostics show promise for challenging cases and personalized treatment.

Conclusions:

• Accurate imaging is crucial for PC diagnosis, staging, and surgical planning.
• A combination of US, scintigraphy, and advanced PET imaging is recommended for comprehensive evaluation.
• Future theranostic strategies hold potential to revolutionize PC management.