C. Douglas Phillips MD, Presenter: Stockholder, MedSolutions, Inc Consultant, Guerbet SA

1) Discuss the history of parathyroid imaging. 2) Understand current imaging modalities and their strengths and weaknesses. 3) Know the current surgical approach to parathyroid disease. 4) Understand the contribution of physiologic imaging of parathyroid disease.

Parathyroid imaging for patients with primary hyperparathyroidism (PHT) has gone through a series of changes that have been brought about because of the necessity of very precise localization of the abnormal parathyroid gland or glands. In the current surgical paradigm, minimally invasive parathyroid surgery (MIPS) is the sought after technique, demanded by patients and offering the lowest cost and most efficacious method to address an abnormal gland. Radiologists offer much to this patient population. Cross-sectional imaging is very often offered to this patient group and precise localization of parathyroid tissue is the goal. Surgeons do not want to operate on normal glands, and they do not want to explore necks. They must be directed to tissue that is parathyroid tissue, and not lymph nodes, and not other potential visceral space masses. Ectopic parathyroid tissue is also a vexing problem. In the setting of ectopic parathyroid tissue, the classic localizing techniques may fail, and a gland that is not evident on the oft-performed and often first line imaging modality (Tc-99m SESTAMIBI) may be problematic. We will discuss the contribution of CT, MR, US and nuclear medicine to visualize parathyroid tissue.

Phillips, C, Parathyroid Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14000629.html