PARATHYROID SONOGRAPHY AND SCINTIGRAPHY IN LOCALIZATION OF PARATHYROID GLAND

Purpose: Based on the widely used minimally-invasive parathyroid surgery, the preoperative diagnosis of parathyroid gland (PTG) is again receiving renewed importance..

The aim of this study was to compare echography and scintigraphy in localization of enlarged and hyperactive PTG in patients with primary, secondary and tertiary hyperparathyreoidism, and correlation with surgery.

Methods and Materials: High resolution ultrasonography (USG) with 10 MHZ probe and two phase and subtraction planar Tc-99m-sestamibi scintigraphy of the neck (by pinhole collimator) and thorax were used in 132 patients (pts), 41 female, 91 male, mean age 56 years, with clinical and biochemical suspicion on hyperparathyroidism.

Results: Positive findings were found with both methods in 63% of cases, and true negative findings in 13% of cases. Positive USG findings were in 69% of cases, positive scintigraphy in 65% of cases. Disconcordant findings representing differences in site and number of PTG detected by both modalities were found in 17% of cases. False negative USG findings were found because of ectopic localization in 5 pts, and in cases of primary hyperplasia. The best results with USG were in cases of primary adenoma (confirmed with surgery) in 93% of cases.

Conclusions: USG and scintigraphy performed by experienced physicians can help to locate enlarged PTG before surgery. In most cases, it is enough to use only one method, (we prefer USG), but in some cases it is necessary to use both methods. In cases of disconcordant findings we recommend postponing surgery.