Parathyroid Imaging and Surgical Management Techniques
Summary
Primary and secondary hyperparathyroidism arises from overproduction of parathyroid hormone and commonly involves single adenomas or multiglandular disease. Accurate localisation of hyperfunctioning parathyroid tissue is essential for successful surgical intervention. Conventional imaging modalities such as high‐resolution ultrasound, dual‐phase 99mTc‐sestamibi scintigraphy and single‐photon emission computed tomography (SPECT/CT) have long formed the backbone of preoperative planning. Emerging functional techniques including positron emission tomography with specific tracers such as 18F‐fluorocholine, alongside multiphase four‐dimensional computed tomography (4D-CT) and dynamic magnetic resonance imaging, have improved sensitivity for small or ectopic glands. Surgical management has evolved from bilateral neck exploration towards minimally invasive parathyroidectomy guided by intraoperative parathyroid hormone monitoring, tailored by precise imaging. Scoring systems combining biochemical markers and imaging features have enhanced prediction of multigland disease, reducing reoperations. Advances in cost‐effectiveness analyses have begun to inform the choice and sequencing of preoperative modalities. Collectively, these developments point to a more individualised approach, balancing diagnostic accuracy, resource utilisation and patient preference, with global implications for standardising care pathways and optimising outcomes.
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Parathyroid Imaging and Surgical Management Techniques publication trend
The graph below shows the total number of articles in parathyroid imaging and surgical management techniques across all publications each year (not limited to Nature Index journals).
Technical terms
Primary hyperparathyroidism: A disorder of excessive parathyroid hormone secretion, most often due to a benign adenoma.
Parathyroid adenoma: A benign tumour of a parathyroid gland causing hormone hypersecretion.
18F‐Fluorocholine PET/CT: A functional imaging modality using a radioactive choline analogue to detect hyperactive parathyroid tissue.
99mTc‐sestamibi SPECT/CT: A hybrid nuclear medicine scan combining sestamibi tracer uptake with CT anatomical detail for gland localisation.
4D-CT: A multiphase computed tomography technique that captures vascular perfusion dynamics to differentiate parathyroid lesions.
Minimally invasive parathyroidectomy: A surgical approach targeting a single gland through a small incision guided by preoperative imaging.
Intraoperative parathyroid hormone monitoring: Real‐time assay of PTH levels during surgery to confirm removal of hyperfunctioning tissue.
References
- Cost-effectiveness of one-stop-shop [18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism. European Journal of Nuclear Medicine and Molecular Imaging (2024).
- The EANM practice guidelines for parathyroid imaging. European Journal of Nuclear Medicine and Molecular Imaging (2021).
- F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study. European Journal of Nuclear Medicine and Molecular Imaging (2017).
- 4D-CT for Preoperative Localization of Abnormal Parathyroid Glands in Patients with Hyperparathyroidism: Accuracy and Ability to Stratify Patients by Unilateral versus Bilateral Disease in Surgery-Naïve and Re-Exploration Patients. American Journal of Neuroradiology (2013).
- Dynamic 4D MRI for Characterization of Parathyroid Adenomas: Multiparametric Analysis. American Journal of Neuroradiology (2015).
- Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers. American Journal of Neuroradiology (2015).
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