Benign neoplasm of parathyroid gland producing excess parathyroid hormone (PTH), resulting in hypercalcemia
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Angiographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Acar N et al: Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate. Ann R Coll Surg Engl. 102(4):294-9, 2020
Bunch PM et al: Parathyroid 4D CT: what the surgeon wants to know. Radiographics. 40(5):1383-94, 2020
Eller M et al: Accuracy of 4-dimensional computed tomography for localization in primary hyperparathyroidism. J Surg Res. 257:15-21, 2020
Woisetschläger M et al: Dual energy 4D-CT of parathyroid adenomas not clearly localized by sestamibi scintigraphy and ultrasonography - a retrospective study. Eur J Radiol. 124:108821, 2020
Yeh R et al: A simple formula to estimate parathyroid weight on 4D-CT, predict pathologic weight, and diagnose parathyroid adenoma in patients with primary hyperparathyroidism. AJNR Am J Neuroradiol. 41(9):1690-7, 2020
Batchala PP et al: Retropharyngeal ectopic parathyroid adenoma versus lymph node: problem solving with CT neck angiogram. J Postgrad Med. 65(4):237-40, 2019
Kluijfhout WP et al: Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis. Eur J Radiol. 88:117-28, 2017
Nafisi Moghadam R et al: Comparative diagnostic performance of ultrasonography and 99mTc-sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and meta-analysis Asian Pac J Cancer Prev. 18(12):3195-200, 2017
Bahl M et al: Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology. 277(2):454-62, 2015
Michaud L et al: A pilot comparison of 18F-fluorocholine PET/CT, ultrasonography and 123I/99mTc-sestaMIBI dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: influence of thyroid anomalies. Medicine (Baltimore). 94(41):e1701, 2015
Bahl M et al: Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT. AJNR Am J Neuroradiol. 35(3):578-81, 2014
Raghavan P et al: Dynamic CT for parathyroid disease: are multiple phases necessary? AJNR Am J Neuroradiol. 35(10):1959-64, 2014
Aliyev A et al: Ectopic parathyroid adenoma localized with MIBI scintigraphy and excised with guide of macroaggregated human serum albumin injection. Clin Nucl Med. 35(3):151-3, 2010
Patel CN et al: Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 65(4):278-87, 2010
Harari A et al: Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy. Am J Surg. 197(6):769-73, 2009
Levine DS et al: Hybrid SPECT/CT imaging for primary hyperparathyroidism: case reports and pictorial review. Clin Nucl Med. 34(11):779-84, 2009
Prommegger R et al: Virtual neck exploration: a new method for localizing abnormal parathyroid glands. Ann Surg. 250(5):761-5, 2009
Randall GJ et al: Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR Am J Roentgenol. 193(2):W139-43, 2009
Thomas DL et al: Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 34(10):651-5, 2009
Usmani S et al: Minimally invasive radionuclide-guided parathyroidectomy using 99mTc-sestamibi in patients with primary hyperparathyroidism: a single-institution experience. Med Princ Pract. 18(5):373-7, 2009
Harari A et al: Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning. Surgery. 144(6):970-6; discussion 976-9, 2008
Parker EE et al: MR imaging of the thoracic inlet. Magn Reson Imaging Clin N Am. 16(2):341-53, x, 2008
Rodgers SE et al: Primary hyperparathyroidism. Curr Opin Oncol. 20(1):52-8, 2008
Zald PB et al: The role of computed tomography for localization of parathyroid adenomas. Laryngoscope. 118(8):1405-10, 2008
Mazzeo S et al: Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism. Radiol Med. 112(5):763-75, 2007
Rodgers SE et al: Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932-40; discussion 940-1, 2006
Bentrem DJ et al: Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid. 12(12):1109-12, 2002
van Dalen A et al: Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology. 220(3):631-9, 2001
Weber AL et al: The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 38(5):1105-29, 2000
Purcell GP et al: Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi. Arch Surg. 134(8):824-8; discussion 828-30, 1999
Ishibashi M et al: Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 39(2):320-4, 1998
Norman J et al: Minimally invasive radioguided parathyroidectomy in the reoperative neck. Surgery. 124(6):1088-92; discussion 1092-3, 1998
Ishibashi M et al: Localization of ectopic parathyroid glands using technetium-99m sestamibi imaging: comparison with magnetic resonance and computed tomographic imaging. Eur J Nucl Med. 24(2):197-201, 1997
Neumann DR et al: Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR Am J Roentgenol. 169(6):1671-4, 1997
Gordon BM et al: Parathyroid imaging with 99m Tc-sestamibi. AJR Am J Roentgenol. 167(6):1563-8, 1996
Lee VS et al: The complementary roles of fast spin-echo MR imaging and double-phase 99m Tc-sestamibi scintigraphy for localization of hyperfunctioning parathyroid glands. AJR Am J Roentgenol. 167(6):1555-62, 1996
Vojvodich SM et al: Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol. 25(2):126-9, 1996
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Parathyroid adenoma (PT Ad)
Definitions
Benign neoplasm of parathyroid gland producing excess parathyroid hormone (PTH), resulting in hypercalcemia
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Angiographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Acar N et al: Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate. Ann R Coll Surg Engl. 102(4):294-9, 2020
Bunch PM et al: Parathyroid 4D CT: what the surgeon wants to know. Radiographics. 40(5):1383-94, 2020
Eller M et al: Accuracy of 4-dimensional computed tomography for localization in primary hyperparathyroidism. J Surg Res. 257:15-21, 2020
Woisetschläger M et al: Dual energy 4D-CT of parathyroid adenomas not clearly localized by sestamibi scintigraphy and ultrasonography - a retrospective study. Eur J Radiol. 124:108821, 2020
Yeh R et al: A simple formula to estimate parathyroid weight on 4D-CT, predict pathologic weight, and diagnose parathyroid adenoma in patients with primary hyperparathyroidism. AJNR Am J Neuroradiol. 41(9):1690-7, 2020
Batchala PP et al: Retropharyngeal ectopic parathyroid adenoma versus lymph node: problem solving with CT neck angiogram. J Postgrad Med. 65(4):237-40, 2019
Kluijfhout WP et al: Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis. Eur J Radiol. 88:117-28, 2017
Nafisi Moghadam R et al: Comparative diagnostic performance of ultrasonography and 99mTc-sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and meta-analysis Asian Pac J Cancer Prev. 18(12):3195-200, 2017
Bahl M et al: Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology. 277(2):454-62, 2015
Michaud L et al: A pilot comparison of 18F-fluorocholine PET/CT, ultrasonography and 123I/99mTc-sestaMIBI dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: influence of thyroid anomalies. Medicine (Baltimore). 94(41):e1701, 2015
Bahl M et al: Prevalence of the polar vessel sign in parathyroid adenomas on the arterial phase of 4D CT. AJNR Am J Neuroradiol. 35(3):578-81, 2014
Raghavan P et al: Dynamic CT for parathyroid disease: are multiple phases necessary? AJNR Am J Neuroradiol. 35(10):1959-64, 2014
Aliyev A et al: Ectopic parathyroid adenoma localized with MIBI scintigraphy and excised with guide of macroaggregated human serum albumin injection. Clin Nucl Med. 35(3):151-3, 2010
Patel CN et al: Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 65(4):278-87, 2010
Harari A et al: Negative preoperative localization leads to greater resource use in the era of minimally invasive parathyroidectomy. Am J Surg. 197(6):769-73, 2009
Levine DS et al: Hybrid SPECT/CT imaging for primary hyperparathyroidism: case reports and pictorial review. Clin Nucl Med. 34(11):779-84, 2009
Prommegger R et al: Virtual neck exploration: a new method for localizing abnormal parathyroid glands. Ann Surg. 250(5):761-5, 2009
Randall GJ et al: Contrast-enhanced MDCT characteristics of parathyroid adenomas. AJR Am J Roentgenol. 193(2):W139-43, 2009
Thomas DL et al: Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 34(10):651-5, 2009
Usmani S et al: Minimally invasive radionuclide-guided parathyroidectomy using 99mTc-sestamibi in patients with primary hyperparathyroidism: a single-institution experience. Med Princ Pract. 18(5):373-7, 2009
Harari A et al: Computed tomography can guide focused exploration in select patients with primary hyperparathyroidism and negative sestamibi scanning. Surgery. 144(6):970-6; discussion 976-9, 2008
Parker EE et al: MR imaging of the thoracic inlet. Magn Reson Imaging Clin N Am. 16(2):341-53, x, 2008
Rodgers SE et al: Primary hyperparathyroidism. Curr Opin Oncol. 20(1):52-8, 2008
Zald PB et al: The role of computed tomography for localization of parathyroid adenomas. Laryngoscope. 118(8):1405-10, 2008
Mazzeo S et al: Multidetector CT in diagnostic work-up of patients with primary hyperparathyroidism. Radiol Med. 112(5):763-75, 2007
Rodgers SE et al: Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932-40; discussion 940-1, 2006
Bentrem DJ et al: Is preoperative investigation of the thyroid justified in patients undergoing parathyroidectomy for hyperparathyroidism? Thyroid. 12(12):1109-12, 2002
van Dalen A et al: Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology. 220(3):631-9, 2001
Weber AL et al: The thyroid and parathyroid glands. CT and MR imaging and correlation with pathology and clinical findings. Radiol Clin North Am. 38(5):1105-29, 2000
Purcell GP et al: Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi. Arch Surg. 134(8):824-8; discussion 828-30, 1999
Ishibashi M et al: Comparison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med. 39(2):320-4, 1998
Norman J et al: Minimally invasive radioguided parathyroidectomy in the reoperative neck. Surgery. 124(6):1088-92; discussion 1092-3, 1998
Ishibashi M et al: Localization of ectopic parathyroid glands using technetium-99m sestamibi imaging: comparison with magnetic resonance and computed tomographic imaging. Eur J Nucl Med. 24(2):197-201, 1997
Neumann DR et al: Comparison of double-phase 99mTc-sestamibi with 123I-99mTc-sestamibi subtraction SPECT in hyperparathyroidism. AJR Am J Roentgenol. 169(6):1671-4, 1997
Gordon BM et al: Parathyroid imaging with 99m Tc-sestamibi. AJR Am J Roentgenol. 167(6):1563-8, 1996
Lee VS et al: The complementary roles of fast spin-echo MR imaging and double-phase 99m Tc-sestamibi scintigraphy for localization of hyperfunctioning parathyroid glands. AJR Am J Roentgenol. 167(6):1555-62, 1996
Vojvodich SM et al: Imaging and surgery in hyperparathyroidism: a 10-year review. J Otolaryngol. 25(2):126-9, 1996
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