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See the separate article on 4D parathyroid CT for an approach to interpretation and the imaging appearance of parathyroid lesions. The classic pattern of parathyroid adenomas, with intense enhancement on arterial phase, washout of contrast on delayed phase, and low attenuation on non-contrast imaging 12 , is present in only a minority of cases 19 .
Best Practice. Ultrasound, scintigraphy, 4D CT, and MRI all demonstrate utility when evaluating a patient with primary hyperparathyroidism. Ultrasound offers a real-time anatomic assessment and high-diagnostic sensitivity, making this the evaluation of choice by many parathyroid surgeons.
Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically.
A special type of imaging method to determine if there are one or more adenomas. A CT scan to check for calcium deposits in your kidney and urinary tract. Bone densitometry to measure bone loss. A 24-hour urine test to measure the amount of calcium lost in your urine.
PET/MRI may be particularly well suited to parathyroid imaging, where available, because of the ability to perform dynamic contrast-enhanced imaging and co-registered 18F-Fluorocholine PET imaging simultaneously with low radiation dose to the thyroid.
(a,b): Parathyroid adenoma on ultrasonography in a patient with primary hyperparathyroidism. (a) A well-defined oval-shaped homogeneously hypoechoic lesion (arrowhead) lateral to the left lobe of thyroid gland (shown by 1, 2 and + sign).(b) Colour Doppler image shows feeding vessel sign (arrowhead).Imaging findings are suggestive of parathyroid adenoma.
A parathyroid scan is a safe and painless imaging procedure healthcare providers use to determine the location of one or more overactive parathyroid gland (s) that are located in an abnormal place in your body. The imaging test is usually an ultrasound or a nuclear scan.
Sestamibi scans are the best scans to find a parathyroid tumor, BUT, they can find only about 50%. In other words, the tumor is present, but the scan does not have the resolution to find it. Therefore, at least 50% of parathyroid tumors cannot be seen with a sestamibi scan. (did you watch our surgery video showing that the scan was wrong?)
Several imaging modalities, including ultrasound, scintigraphy, CT, and MRI demonstrate efficacy when evaluating parathyroid pathology. Imaging can be considered functional or anatomic based on an ability to detail contents of the neck while locating an adenoma.
KEY FACTS Imaging • Round or oval, well-circumscribed, solid mass • Typically 1-3 cm in size • Most are hypoechoic to thyroid and homogeneous • Some show cystic degeneration • Calcification is rare; more common in carcinoma or hyperplasia due to hyperparathyroidism • Location Upper glands: Posterior to upper or mid pole of thyroid….