Hyperparathyroidism: comparison of MR imaging with radionuclide scanning.

Abstract

Twenty-three patients with hyperparathyroidism were evaluated preoperatively with magnetic resonance (MR) imaging. Twenty patients also underwent thallium-201/technetium-99m scintigraphy. Of 22 patients with primary hyperparathyroidism, 12 had persistent or recurrent disease. One had secondary hyperparathyroidism due to end-stage renal disease. MR imaging allowed accurate localization of abnormal parathyroid glands in 64% evaluated prospectively and 82% evaluated retrospectively. Scintigraphy allowed localization of 60% evaluated prospectively and 70% retrospectively. The two imaging modalities together allowed detection of 68% evaluated prospectively and 91% retrospectively. MR imaging allowed detection of two of five mediastinal adenomas evaluated prospectively and four of five retrospectively. In patients who underwent both imaging studies, MR was more successful in those with previous neck surgery (73% evaluated prospectively and 91% retrospectively) than in those with no prior surgery (57% prospectively and 71% retrospectively). Scintigraphy allowed accurate localization in 64% evaluated prospectively and 64% retrospectively in patients with previous surgery versus 57% prospectively and 86% retrospectively in patients with no prior neck surgery. Four false-positive results were obtained with MR imaging and three with scintigraphy. MR imaging was useful for parathyroid localization in patients with hyperparathyroidism, particularly in patients requiring additional surgery.

Hyperparathyroidism - Comparison of Flash Imaging with Spin Echo MR Imaging

“…As reported by other investigators, many parathyroid lesions were iso-intense with fat on T2-weighted SE images in our study (7,9,12,14,18). This is problematic because parathyroid lesions are often enclosed by a pad of fatty tissue (9,21).…”

“…Preoperative localization is clinically beneficial because this can minimize operation time and the risk of surgical complications (9,14,18).,Noninvasive examinations such as ultrasound, CT, or scintigraphy are widely used (5,7). With the improvement of spatial resolution, MR imaging has been one of the techniques used for detection of parathyroid abnormalities.…”

“…With the improvement of spatial resolution, MR imaging has been one of the techniques used for detection of parathyroid abnormalities. There are several reports on the detectability of spin-echo (SE) MR imaging for localization of hyperparathyroidism (1, 7,9,11,12,14,18). However, to our knowledge, themare no reports on fast low angle shot (FLASH) applied to this condition.…”

Localization of parathyroid enlargement: experience with technetium-99m methoxyisobutylisonitrile and thallium-201 scintigraphy, ultrasonography and computed tomography

“…We were unable to compare the performance of magnetic resonance imaging (MRI) as it was not available in our institution at the time. The role of this technique, which has been used to a limited extent over the last 10 years to localize enlarged parathyroids [31][32][33][34][35][36], has still not been fully defined. MRI is certainly attractive given its ability to permit imaging in the sagittal, coronal and transaxial planes, the lack of exposure to ionizing radiation, the excellent delineation of vascular structures without the need for contrast, the excellent spatial resolution and the fact that it enables some degree of in vivo tissue characterization.…”

“…MRI is certainly attractive given its ability to permit imaging in the sagittal, coronal and transaxial planes, the lack of exposure to ionizing radiation, the excellent delineation of vascular structures without the need for contrast, the excellent spatial resolution and the fact that it enables some degree of in vivo tissue characterization. Nevertheless, MRI has not been shown to improve the localization of enlarged parathyroid glands significantly above that achieved by other techniques [33][34][35][36]. This, together with its high cost and somewhat limited availability, prevent MRI from being a routine screening test.…”