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Review
. 2023 Dec 22;14(1):25.
doi: 10.3390/diagnostics14010025.

Diagnostic Performance of Magnetic Resonance Imaging for Parathyroid Localization of Primary Hyperparathyroidism: A Systematic Review

Max H M C Scheepers  1 , Zaid Al-Difaie  1 , Lloyd Brandts  2 , Andrea Peeters  2 , Bjorn Winkens  3 , Mahdi Al-Taher  4 , Sanne M E Engelen  4 , Tim Lubbers  1   4 , Bas Havekes  5   6 , Nicole D Bouvy  4 , Alida A Postma  7
Affiliations
Review

Diagnostic Performance of Magnetic Resonance Imaging for Parathyroid Localization of Primary Hyperparathyroidism: A Systematic Review

Max H M C Scheepers et al. Diagnostics (Basel). .

Abstract

Accurate preoperative localization is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Preoperative localization can be challenging in patients with recurrent and/or multigland disease (MGD). This has led clinicians to investigate multiple imaging techniques, most of which are associated with radiation exposure. Magnetic resonance imaging (MRI) offers ionizing radiation-free and accurate imaging, making it an attractive alternative imaging modality. The objective of this systematic review is to provide an overview of the diagnostic performance of MRI in the localization of PHPT. PubMed and Embase libraries were searched from 1 January 2000 to 31 March 2023. Studies were included that investigated MRI techniques for the localization of PHPT. The exclusion criteria were (1) secondary/tertiary hyperparathyroidism, (2) studies that provided no diagnostic performance values, (3) studies published before 2000, and (4) studies using 0.5 Tesla MRI scanners. Twenty-four articles were included in the systematic review, with a total of 1127 patients with PHPT. In 14 studies investigating conventional MRI for PHPT localization, sensitivities varied between 39.1% and 94.3%. When employing more advanced MRI protocols like 4D MRI for PHPT localization in 11 studies, sensitivities ranged from 55.6% to 100%. The combination of MR imaging with functional techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy, with sensitivities ranging from 84.2% to 100% in five studies. Despite the limitations of the available evidence, the results of this review indicate that the combination of MR imaging with functional imaging techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy. Further research on emerging MR imaging modalities, such as 4D MRI and PET/MRI, is warranted, as MRI exposes patients to minimal or no ionizing radiation compared to other imaging modalities.

Keywords: diagnostics; magnetic resonance imaging; preoperative; primary hyperparathyroidism.

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Conflict of interest statement

Z.-Al-Difaie has no conflict of interest to disclose. M. Scheepers has no conflict of interest to disclose. L. Brandts has no conflict of interest to disclose. A. Peeters has no conflict of interest to disclose. B. Winkens has no conflict of interest to disclose. M. Al-Taher has no conflict of interest to disclose. S. Engelen has no conflict of interest to disclose. T. Lubbers has no conflict of interest to disclose. B. Havekes has no conflict of interest to disclose. N.D. Bouvy has no conflict of interest to disclose. A.A. Postma: Institutional Grant Siemens Healthineer Bayer Healthcare.

Figures

Figure 1
Figure 1
Flowchart: identification, screening, eligibility, and selection process.
See this image and copyright information in PMC

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