Imaging

Parathyroid Adenoma

Preliminary Diagnosis: Parathyroid Adenoma

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound of the thyroid and parathyroid bed

II. Describe the advantages and disadvantages of this technique for diagnosis of parathyroid adenoma.

Advantages

  • Highly portable and fast imaging modality.

  • Does not expose patients to ionizing radiation

  • May help guide treatment and biopsy

  • Useful in evaluating the vascularity of a focal mass or other abnormality

Disadvantages

  • Poorly sensitive and specific in evaluating for a parathyroid adenoma

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • Nuclear medicine technetium 99 M Sestamibi imaging

  • 3-D parathyroid CT imaging

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of parathyroid adenoma.

Nuclear medicine technetium 99 M Sestamibi imaging

Advantages

  • Highly sensitive and specific in evaluating for a focal parathyroid adenoma

Disadvantages

  • Does not offer detailed evaluation of the surrounding soft tissues and osseous structures

  • May be contraindicated in pregnant patients and those breast feeding

3-D Parathyroid CT imaging

Advantages

  • Offers exquisite detail of the surrounding soft tissues and osseous structures

  • Offers exquisite detail of a parathyroid adenoma and characterizes a parathyroid adenoma in comparison to surrounding soft tissues

  • Highly sensitive and specific in detecting and characterizing ectopic parathyroid adenomas

Disadvantages

  • Exposes patients to large amounts of ionizing radiation

VI. What are the contraindications for the alternative imaging techniques?

Nuclear medicine technetium 99 M Sestamibi imaging

  • May be contraindicated in pregnant patients and those breast feeding

3-D Parathyroid CT imaging

  • May be contraindicated in pregnant patients

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