title: Scintigraphic techniques in primary hyperparathyroidism: from pre-operative localisation to intra-operative imaging.
abstract: BACKGROUND
  Primary hyperparathyroidism (PHPT) is an increasingly diagnosed disease worldwide. In most cases, PHPT is related to the presence of a solitary parathyroid adenoma (PA). Fifty percent or more of newly diagnosed PHPT patients are asymptomatic, and there is debate among endocrinologists and endocrine surgeons about whether or not such patients should be treated.
  Usually, in a PHPT patient with a solitary PA that is well localised pre-operatively, a parathyroidectomy with limited or minimally invasive neck exploration is offered. The diffusion of minimally invasive neck exploration procedures is a consequence of the significant improvement in the accuracy of pre-operative imaging (mainly scintigraphic) techniques; these techniques have changed the surgical strategy to PHPT, from the wide traditional bilateral neck exploration to limited neck exploration.
  
  
  METHODS
  The present review considers developments during the past 10-15 years with regard to both the accuracy of pre-operative localising imaging techniques and intra-operative minimally invasive procedures in order to provide endocrinologists and endocrine surgeons with further information about the newly available diagnostic and therapeutic tools for use in PHPT patients with a solitary PA.
authors.affiliation: Service of Nuclear Medicine, S. Maria della Misericordia Hospital, Viale Tre Martiti, 140, 45100, Rovigo, and Regional Center of Nuclear Medicine, University of Pisa, Italy. domenico.rubello@libero.it
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Milton D
authors.initials: MD
authors.lastname: Gross
authors.forename: Giuliano
authors.initials: G
authors.lastname: Mariani
authors.forename: Adil
authors.initials: A
authors.lastname: AL-Nahhas
mesh_terms: D000236:Adenoma / Q000378:metabolism; D004058:Diffusion; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D007091:Image Processing, Computer-Assisted; D009333:Neck / Q000473:pathology; D010280:Parathyroid Glands / Q000378:metabolism; D010282:Parathyroid Neoplasms / Q000378:metabolism; D016105:Parathyroidectomy; D011877:Radionuclide Imaging / Q000379:methods*; D019275:Radiopharmaceuticals / Q000494:pharmacology; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi / Q000494:pharmacology; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi