Parathyroid Adenoma Evaluation Utilizing SPECT / CT Imaging

J Am Osteopath Coll Radiol 2018; Vol. 7, Issue 1 P hyperparathyroidism is a common endocrine disorder classically manifesting with elevated serum parathyroid hormone and calcium levels. The most common cause of primary hyperparathyroidism is a parathyroid adenoma, and the treatment of choice is surgical removal. Modern surgical management benefits from presurgical evaluation and localization of suspected abnormal gland(s), with a shift toward minimally invasive approaches. Complementing anatomic imaging, nuclear medicine offers unique functional evaluation of parathyroid glands that can be used in the workup of patients with hyperparathyroidism. Historically, it was common to rely solely on planar imaging for identifying parathyroid adenomas in hyperparathyroidism. However, planar imaging is limited by the lack of precise anatomic localization and overlapping of radioactivity from other background tissues. This is particularly problematic in parathyroid scintigraphy, as it is often necessary to distinguish overlying thyroid from closely adjacent parathyroid activity. Combining anatomic information and localization of functional imaging using contemporary SPECT/CT affords more precise localization necessary to guide presurgical treatment planning. In this article, we review imaging protocols, scintigraphic findings, and pitfalls in parathyroid scintigraphy with an emphasis on SPECT/CT imaging.