Parathyroid imaging

Developments in technology mean that it is now possible to localize abnormal parathyroid glands by a variety of imaging methods. There remain a number of unresolved issues. With all commonly used methods (radionuclide imaging, ultrasound, computed tomography and magnetic resonance imaging), there are wide variations in sensitivity of detection of glands, and in many cases this variation is not explained satisfactorily. The necessity for imaging is questioned by many parathyroid surgeons, particularly before a first operation. However, parathyroid surgery is itself changing, with a trend towards more limited neck exploration, which requires localization of the glands pre-operatively. This review describes the methods available for localizing parathyroid glands, with their advantages and limitations, and discusses the role of the techniques prior to surgery.