Role of Imagery in Preoperative Evaluation of Parathyroid Lesions in Hyperparathyroidism

Background: Hyperparathyroidism (HPT) is an endocrine disease characterized by a hypercalcemic state due to hyper secretion of parathyroid hormone. Imaging in parathyroid disease (hyperparathyroidism) is aimed at localizing enlarged parathyroid glands after a biochemical diagnosis of hyperparathyroidism has been made. By precisely identifying the number and location of abnormal parathyroid glands, surgical parathyroidectomy can be considered and planned. Objective: This article discusses our experience with hyperparathyroidism, from a radiological point of view, the commonly used techniques for imaging the parathyroid glands and their role in the preoperative evaluation of patients with primary hyperparathyroidism in our tertiary hospital center. The commonly used noninvasive imaging techniques: songraphy, CT, and MRItheir advantages and limitations will be discussed. Material and methods: We have carried out a retrospective study in patients admitted for surgical treatment between January 2009 to December 2013, preoperatively diagnosed with HPT. All patients were hospitalized and prepared for surgery in the Service of Endocrinology and Nephrology where they came from. The data on patient’s histories, diagnostic procedures, treatment and complications were acquired from medical reports. In order to detect and locate abnormal parathyroid tissue for preoperative localization study of diseased gland, we have used neck ultrasonography (NUS), computed axial tomography (CT) and magnetic resonance imaging (MRI). Conclusion: The treatment of parathyroid disease is primarily surgical. However, parathyroidectomy would not be successful without accurate preoperative localization of the abnormal gland. This requires skilled radiologists at performing ultrasonography, Ct and other imaging modalities to guide the surgeon in localizing the abnormal gland(s).