Preoperative Imaging Techniques in Primary Hyperparathyroidism: A Review.

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Preoperative Imaging Techniques in Primary Hyperparathyroidism: A Review.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 06;:

Authors: Bunch PM, Kelly HR

Abstract
Importance: Successful minimally invasive parathyroidectomy requires confident and accurate preoperative localization. Several noninvasive imaging techniques are well established for preoperative localization, and others are emerging.
Observations: Ultrasonography and sestamibi imaging are established preoperative localization techniques with good sensitivity and positive predictive value. Multiphase 4-dimensional computed tomography is a newer technique with arguably superior performance, particularly in the setting of negative or discordant ultrasonography and sestamibi imaging, residual or recurrent primary hyperparathyroidism following a previous surgical operation, and multiglandular disease. Emerging techniques that may further facilitate confident and accurate preoperative localization include ultrasonography, elastography, positron emission tomography, and 4-D magnetic resonance imaging.
Conclusions and Relevance: The optimal imaging localization algorithm for hyperparathyroidism remains undetermined, but a combination of techniques tailored to the specific scenario will likely yield the best outcomes. An algorithm is proposed that considers test performance, surgeon confidence, patient-specific factors, cost, local radiologic expertise, and patient radiation exposure.

PMID: 30193297 [PubMed - as supplied by publisher]

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