What is the role of CT scanning and MRI in the workup of primary hyperparathyroidism?

Updated: Dec 24, 2020
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The use of four-dimensional (4D) CT scanning for parathyroid localization is increasing. [13]  The study can be done either without contrast or with dynamic contrast imaging. Parathyroid adenomas enhance brightly with contrast due to their high vascularity, and then the contrast quickly washes out. Four-dimensional CT scan studies have shown sensitivity rates as high as 88%. [14, 15]  The largest retrospective study available at the time of this writing reported an overall sensitivity of 79%. [16]  Like other imaging studies, 4D-CT scanning is less sensitive in detecting multiglandular disease (43-67% [17, 18] ) than single-gland disease (92-94% [19, 20] ). Some studies have argued that a two-phase CT scan is as effective as the 4D modality in the localization of the parathyroids, including in cases of small adenomas, reoperation, and multiglandular disease, with less radiation exposure for the patient. [21] ) However, while the two-phase technique does lower radiation exposure, this is probably at the cost of optimal accuracy. [22, 20]

A small, left inferior parathyroid adenoma as demo A small, left inferior parathyroid adenoma as demonstrated on a 4D-CT scan. The left panel is a single image from the early contrast phase showing intense enhancement. The right panel shows rapid washout of contrast. The white arrows point to the adenoma.

Magnetic resonance imaging (MRI) has not commonly been used for parathyroid localization in most centers, and studies regarding this modality have generally been small and have all utilized contrast. Newer techniques, conceptually similar to the 4D-CT scanning, are being developed that may increase the sensitivity of MRI and expand its usefulness. [23, 24, 25]


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