Contemporary Multimodality Imaging of Primary Hyperparathyroidism

Epidemiologic features, relevant anatomy, pathophysiology, and management of primary hyperparathyroidism are described, and the relative merits of different localization techniques are discussed.

Course ID: Q00712 Category:
Modalities: , , , ,


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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


  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


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