Contemporary Multimodality Imaging of Primary Hyperparathyroidism

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.00
Procedures: 2.00
Neck and Chest: 2.00

Magnetic Resonance Imaging: 2.00
Procedures: 2.00
Neurological: 2.00

Nuclear Medicine Technology: 2.00
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Musculoskeletal and Endocrine Sections: 2.75

Sonography: 2.75
Procedures: 2.75
Superficial Structures and Other Sonographic Procedures: 2.75

Outline

1. Introduction
2. Epidemiologic Features
3. Anatomy and Physiology
4. Clinical Presentation and Diagnosis
5. Management
6. Localization Techniques
   1. US Localization
   2. 99mTc-Sestamibi Scanning Localizaion
   3. Four-Dimensional CT localization
7. MRI Localization
   1. Choline PET and PET/CT Localization
   2. Venous Sampling with Parathyroid Arteriography
8. Persistent or Recurrent PHPT
9. Conclusion

Objectives

Upon completion of this course, students will:

1. list the biochemical characteristics associated with PHPT
2. identify individuals at higher risk for PHPT
3. understand where the majority of PHPT originate
4. identify common locations for ectopic inferior parathyroid glands
5. understand how PHPT is diagnosed
6. identify common locations for ectopic parathyroid glands
7. explain the role of medical imaging following a PHPT diagnosis
8. understand the criteria for surgery in the setting of asymptomatic PHTP
9. list advantages associated with minimally invasive parathyroid surgery
10. identify cost-effective initial imaging recommended for PHTP cases
11. explain how patient swallowing or head turning with US aids with gland localization
12. list abnormal adenoma characteristics seen on US
13. identify advantages and drawbacks associated with US imaging and PHPT
14. understand when US-guided FNA is recommended in PHPT cases
15. list factors associated with ^99mTc-sestamibi uptake in overactive parathyroid glands
16. understand the normal biodistribution of ^99mTc-sestamibi
17. understand the imaging parameters for ^99mTc-sestamibi SPECT/CT imaging
18. identify the benefits of SPECT/CT versus SPECT alone
19. describe the different protocols used in scintigraphy for adenoma localization
20. list false positives and false negatives associated with ^99mTc-sestamibi imaging
21. identify thyroid avid radiopharmaceuticals used in adenoma scintigraphy protocols
22. identify the imaging protocol with the highest accuracy for adenoma localization
23. describe the intraoperative adenoma localization protocol
24. describe the 4D CT protocol
25. list drawbacks associated with 4D CT
26. describe the image pattern on 4D CT that differentiates thyroid from an adenoma
27. understand anatomy that will show peak contrast enhancement on 4D CT
28. understand the advantages of 4D CT over ^99mTc-sestamibi
29. describe the MRI signal intensities associated with an adenoma
30. understand how MRI heterogeneous signal intensity can aid in lesion localization
31. describe characteristics of contrast-enhanced multiparametric dynamic MRI and adenomas
32. identify radiotracers used for parathyroid adenoma PET imaging
33. understand PET imaging protocols using ¹¹C-choline
34. understand the normal biodistribution of ¹⁸F-fluorocholine
35. describe the imaging differences of PET/CT compared to SPECT/CT
36. understand anatomical uptake patterns associated with ¹¹C-choline
37. describe which PET radiotracer has the most favorable properties
38. explain what cohort of PHPT patients should undergo venous sampling
39. identify venous sampling points associated with eutopic adenomas
40. identify characteristics associated parathyroid arteriography
41. describe reasons contributing to persistent or recurrent PHPT
42. identify imaging options when repeat surgery is considered for recurrent PHPT
43. list recommendations in post parathyroidectomy patients with multigland disease