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Related Experiment Video

Updated: Jul 6, 2026

Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging
07:12

Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging

Published on: August 17, 2022

Imaging localization strategies in primary hyperparathyroidism.

A Adarve Castro1, V Soria Utrilla2, J M Castro-García3

  • 1Departamento de Radiología y Medicina Física, Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Radiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain.

Radiologia
|July 4, 2026
PubMed
Summary
This summary is machine-generated.

Preoperative localization for parathyroid glands can be challenging due to anatomical variability. This study found contrast-enhanced ultrasound (CEUS) to be the most accurate imaging test for discordant cases in primary hyperparathyroidism (PHP).

Keywords:
ConcordanceConcordanciaContrast-enhanced ultrasoundEcografíaEcografía con contrasteHiperparatiroidismo primarioPositron emission tomography computed tomographyPrimary hyperparathyroidismSingle photon emission computed tomographyTomografía computarizada por emisión de fotón únicoTomografía computarizada por emisión de positronesUltrasonography

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Last Updated: Jul 6, 2026

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Area of Science:

  • Endocrinology and Nuclear Medicine
  • Surgical Anatomy and Imaging

Background:

  • Parathyroid gland anatomical variability complicates preoperative localization, essential for minimally invasive parathyroidectomy.
  • Optimal minimally invasive parathyroidectomy relies on concordant results from at least two preoperative imaging tests.
  • Current imaging modalities for primary hyperparathyroidism (PHP) localization vary in accuracy and concordance with surgical findings.

Purpose of the Study:

  • To assess the concordance of various imaging tests with surgical outcomes in patients with PHP.
  • To establish an evidence-based algorithm for the optimal sequencing of preoperative localization tests.

Main Methods:

  • A prospective study involving 93 patients with PHP undergoing initial 99mTc-sestamibi SPECT/CT and cervical ultrasound.
  • Discordant initial imaging results prompted secondary imaging with contrast-enhanced ultrasound (CEUS), CT, MRI, or 18F-choline PET/CT.
  • Sensitivity, positive predictive value, accuracy, and Cohen's Kappa index (k) were calculated for each modality against surgical findings.

Main Results:

  • Overall, ultrasound demonstrated higher concordance (k=0.67) than 99mTc-sestamibi SPECT/CT (k=0.55) with surgical outcomes.
  • In cases with discordant initial imaging, CEUS (k=0.64) and 18F-choline PET/CT (k=0.62) showed the highest concordance.
  • MRI exhibited the lowest concordance (k=0.14) in discordant cases, indicating limited utility for parathyroid localization in this context.

Conclusions:

  • In concordant cases, both ultrasound and 99mTc-sestamibi SPECT/CT offer moderate preoperative localization accuracy for PHP.
  • For discordant cases, CEUS is the most reliable imaging modality, followed by 18F-choline PET/CT, for guiding surgical intervention.
  • An algorithm prioritizing CEUS and 18F-choline PET/CT in discordant scenarios can optimize preoperative localization and surgical planning.