Choline positron emission tomography/computed tomography imaging in parathyroid neoplasms

Parathyroid glands are the smallest organs in our body,that regulate calcium metabolism, by producing parathyroid hormone (PTH). They are four, at least, as they might be either supernumerary or ectopic, especially in patients with chronic renal failure. Hyperparathyroidism (HPT) is a common endocrine disease, characterized by hormone imbalance, which leads to increased secretion of PTH. Primary hyperparathyroidism (PHPT) is caused by hyperfunctioning parathyroid glands, mainly by a solitary parathyroid adenoma and less frequently by parathyroid hyperplasia or double parathyroid adenomas. The alteration in calcium homeostasis, that stimulates the excessive production of PTH is called secondary HPT. Diagnosis of HPT may be clinical or incidental on biochemical screening. Surgical removal of hyperfunctioning parathyroid gland is the only curative treatment available at the moment. Minimally invasive parathyroidectomy (MIP) seems to be the surgical procedure of choice, as it demonstrates multiple advantages, such as reduced duration of surgery shorter hospitalization, with better cosmetic outcome and fewer patient complications. Preoperative imaging is therefore essential for those patients who are going to be treated surgically.