To evaluate the accuracy of one-stop (single patient attendance) SPECT-CT-guided ultrasound (US) in the localisation of parathyroid adenomata (PTA). Secondary aims included analysing the effect of multiple PTA and concurrent thyroid disease on sensitivity. Patients with hyperparathyroidism that had undergone parathyroidectomy were identified over a 5 year period. Pathological correlation with results from pre-operative sestamibi SPECT-CT followed by targeted US of the neck was performed. The number of glands, location and presence of concurrent thyroid disease were reviewed. 146 patients were included (88% single gland, 7% multigland and 5% negative explorations). The sensitivity and specificity of SPECT-CT-guided US were 83% and 96% respectively. The sensitivity was higher for single gland (87%) as compared to multigland disease (70%). The addition of ultrasound significantly increased the sensitivity of the technique (p<0.001). The presence of concurrent thyroid disease (nodules/thyroiditis) did not adversely affect sensitivity (85% CI 74.2-93.1%) compared with normal or atrophic glands (82% CI 72.3-89.7%). SPECT-CT guided US represents a useful means of localising PTA, thereby aiding the decision to undertake minimally-invasive or exploratory surgery. The one-stop approach offers patient convenience and enables the radiologist to use the additive benefits of both modalities to optimise localisation. The technique is less sensitive in multi-gland disease, but concurrent thyroid disease does not adversely affect sensitivity.

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