Contemporary localization diagnostics in primary hyperparathyroidism. Review of visualization techniques including ultrasonography, PTH washout, 99mTc-MIBI scintigraphy, and 18F-choline PET

Abstract

Introduction: Primary hyperparathyroidism is a set of symptoms caused by overproduction of parathormone (PTH), leading to impaired calcium and phosphorus metabolism. Proper diagnosis and detection of a parathyroid adenoma, including ectopic ones, is crucial to confirm the diagnosis and to tailor further treatment. In clinical practice, preoperative localization of parathyroid adenomas is a difficult task. Conventional imaging studies such as ultrasonography (US) and 99mTc-MIBI scintigraphy often cause unequivocal results; therefore, additional examinations are needed. The following paper discusses currently available diagnostic methods that could help in doubtful cases, and which should be considered during localization of parathyroid lesions.

Material and methods: When writing the following paper, we researched medical databases, such as PubMed and Google Scholar, for papers published in 2000-2024 with special attention paid to the latest articles published in the past 5 years. The presented data are gathered from 66 selected publications on primary hyperparathyroidism and contemporary methods of localization diagnostics by keywords: "primary hyperparathyroidism", "parathyroids", "parathormone", "MIBI", "scintigraphy", "parathyroids ultrasonography", "parathyroid adenoma", "parathyroid localization diagnostics", "imaging studies in hyperparathyroidism", "minimally invasive surgery in hyperparathyroidism", "18F-choline", "PET", and "PTH washout."

Results: Use of positron emission tomography with 18F-choline (18F-FCH PET/CT) or parathormone washout from ultrasound-guided fine-needle aspiration (FNA) increases the effectiveness of localization diagnostics. Due to the high sensitivity of those tests, contemporary reports emphasize their value more often than ever. These examinations have a great impact on the accurate identification of parathyroid lesions, and in some cases they allow minimally invasive surgery to be performed.

Conclusions: The following paper underlines a need for determination of a perfect tool for primary hyperparathyroidism localization diagnostics based on its sensitivity and availability; however, contemporary available tests and exams when combined may bring great results and allow a patient to be qualified for a minimally invasive surgical treatment.

Keywords: MIBI; PET; PTH washout; imaging studies in hyperparathyroidism; minimally invasive surgery in hyperparathyroidism; parathyroid adenoma; parathyroid localization diagnostics; parathyroids ultrasonography; primary hyperparathyroidism; scintigraphy.