Parathyroid imaging

The most common indication for parathyroid imaging is hyperparathyroidism, which is caused by a solitary parathyroid adenoma in most patients. The primary function of parathyroid imaging is localization of the abnormal parathyroid gland, enabling the surgeon to pursue a minimally invasive resection. Ultrasound and Tc-99m sestamibi scintigraphy are the mainstays for the preoperative localization of culprit lesions. The emerging modality of SPECT-CT can improve the sensitivity of Tc-99m sestamibi scintigraphy and its use is encouraged when available. CT and MR imaging are useful as adjuncts, particularly as anatomic correlates to suspected ectopic glands on Tc-99m sestamibi scintigraphy that are inaccessible to ultrasound. In cases of suspected parathyroid carcinoma, preoperative CT or MR imaging is recommended for surgical planning.