title: The role of radionuclide imaging in the surgical management of primary hyperparathyroidism.
abstract: Primary hyperparathyroidism is a frequent and potentially debilitating endocrine disorder for which surgery is the only curative treatment. The modalities of parathyroid surgery have changed over the last 2 decades, as conventional bilateral neck exploration is no longer the only surgical approach. Parathyroid scintigraphy plays a major role in defining the surgical strategy, given its ability to orient a targeted (focused) parathyroidectomy and to recognize ectopic locations or multiglandular disease. This review, which represents a collaborative effort between nuclear physicians, endocrinologists, and endocrine surgeons, emphasizes the importance of performing imaging before any surgery for primary hyperparathyroidism, even in the case of conventional bilateral neck exploration. We discuss the advantages and drawbacks of targeted parathyroidectomy and the performance of various scintigraphic protocols to guide limited surgery. We also discuss the optimal strategy to localize the offending gland before reoperation for persistent or recurrent hyperparathyroidism. Finally, we describe the potential applications of novel PET tracers, with special emphasis on (18)F-fluorocholine.
authors: Department of Nuclear Medicine, Haut-Lévêque Hospital, CHU de Bordeaux, CNRS-UMR 5287, Translational and Advanced Imaging Laboratory (TRAIL), University of Bordeaux, Bordeaux, France elif.hindie@chu-bordeaux.fr.
authors: Elif
authors: E
authors: Hindié
authors: Department of Nuclear Medicine, Haut-Lévêque Hospital, CHU de Bordeaux, CNRS-UMR 5287, Translational and Advanced Imaging Laboratory (TRAIL), University of Bordeaux, Bordeaux, France.
authors: Paolo
authors: P
authors: Zanotti-Fregonara
authors: Department of Endocrinology, CHU de Bordeaux, University of Bordeaux, Bordeaux, France.
authors: Antoine
authors: A
authors: Tabarin
authors: Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors: Domenico
authors: D
authors: Rubello
authors: Department of Nuclear Medicine, Lyon Sud Hospital, Hospices Civiles de Lyon, Lyon, France.
authors: Isabelle
authors: I
authors: Morelec
authors: Department of Endocrine Surgery, CHU de Bordeaux, University of Bordeaux, Bordeaux, France.
authors: Tristan
authors: T
authors: Wagner
authors: Department of Endocrine Surgery, La Timone Hospital, Aix-Marseille University, Marseille, France; and.
authors: Jean-François
authors: JF
authors: Henry
authors: Department of Nuclear Medicine, La Timone Hospital, CERIMED, Aix-Marseille University, Marseille, France.
authors: David
authors: D
authors: Taïeb
mesh_terms: D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D057234:Preoperative Period; D011877:Radionuclide Imaging / Q000379:methods*; D025321:Surgery, Computer-Assisted
keywords: 11C-methionine; 18F-fluorocholine; MIBI; PET/CT; SPECT/CT; dual-tracer; hyperparathyroidism; parathyroid subtraction imaging