Gulati S, Chumber S, Puri G, Spalkit S, Damle NA, Das CJ. Multi-modality parathyroid imaging: A shifting paradigm. World J Radiol 2023; 15(3): 69-82 [PMID: 37035829 DOI: 10.4329/wjr.v15.i3.69]
Corresponding Author of This Article
CJ Das, FRCP, MBBS, MD, Professor, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Aurobindo Marg Ansari Nagar, New Delhi 110029, Delhi, India. docchandan17@gmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Mar 28, 2023; 15(3): 69-82 Published online Mar 28, 2023. doi: 10.4329/wjr.v15.i3.69
Multi-modality parathyroid imaging: A shifting paradigm
Shrea Gulati, Sunil Chumber, Gopal Puri, Stanzin Spalkit, N A Damle, CJ Das
Shrea Gulati, Stanzin Spalkit, CJ Das, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Sunil Chumber, Gopal Puri, Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
N A Damle, Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Author contributions: Gulati S, Das JC, Spalkit S wrote the paper; Chumber S and Puri G provided the surgical expertise; Damle N provided the nuclear medicine expertise. All authors were involved in careful editing of the final manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: CJ Das, FRCP, MBBS, MD, Professor, Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Aurobindo Marg Ansari Nagar, New Delhi 110029, Delhi, India. docchandan17@gmail.com
Received: December 24, 2022 Peer-review started: December 24, 2022 First decision: January 3, 2023 Revised: January 20, 2023 Accepted: March 1, 2023 Article in press: March 1, 2023 Published online: March 28, 2023 Processing time: 92 Days and 15 Hours
Abstract
The goal of parathyroid imaging in hyperparathyroidism is not diagnosis, rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach. Hence, the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration. The common causes include solitary parathyroid adenoma, multiple parathyroid adenomas, parathyroid hyperplasia and parathyroid carcinoma. It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging. The various imaging modalities available include high resolution ultrasound of the neck, nuclear imaging studies, four-dimensional computed tomography (4D CT) and magnetic resonance imaging. Contrast enhanced ultrasound is a novel technique which has been recently added to the armamentarium to differentiate between parathyroid adenomas and its mimics. Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.
Core Tip: Parathyroid adenoma is the commonest cause of primary hyperparathyroidism, the management of which lies in definitive surgery. Accurate preoperative imaging is of prime importance to facilitate surgery. Imaging modalities include radiological investigations like ultrasound, four-dimensional computed tomography and magnetic resonance imaging which provide anatomical localization and nuclear scans like MIBI, single photon emission computed tomography and Fluoro-choline positron emission tomography which provide functional imaging details. Contrast-enhanced ultrasound is a novel modality which is being explored in the evaluation of parathyroid adenomas.
