title: Complementary nature of radiotracer parathyroid imaging and intraoperative parathyroid hormone assays in the surgical management of primary hyperparathyroid disease: case report and review.
abstract: OBJECTIVE
  This article illustrates the complementary nature of preoperative radionuclide parathyroid imaging and intraoperative rapid parathyroid hormone (PTH) assays in primary hyperparathyroid disease. The authors review the literature on these procedures and compare this protocol and its cost-effectiveness with those of the classic four-gland exploration.
  
  
  METHODS
  Preoperative parathyroid imaging with Tc-99m MIBI and intraoperative rapid PTH assays were performed at the time of neck exploration.
  
  
  RESULTS
  One of two parathyroid adenomas seen on radionuclide images would have been missed if the authors had relied solely on the initial decrease in PTH assay value to a normal level.
  
  
  CONCLUSIONS
  Tc-99m MIBI imaging and intraoperative rapid PTH assays are complementary; when used together, they lessen the likelihood that abnormal parathyroid glands will be overlooked. This experience and that of others suggest these combined procedures are cost-effective.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710, USA. wilki017@mc.duke.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Wilkinson
authors.forename: G S
authors.initials: GS
authors.lastname: Leight
authors.forename: S C
authors.initials: SC
authors.lastname: Garner
authors.forename: S
authors.initials: S
authors.lastname: Borges-Neto
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000601:surgery; D000368:Aged; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery; D006962:Hyperparathyroidism, Secondary; D007432:Intraoperative Period; D008297:Male; D010280:Parathyroid Glands / Q000000981:diagnostic imaging*; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000175:diagnosis / Q000601:surgery; D016105:Parathyroidectomy; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
chemical_list: D010281:Parathyroid Hormone; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi