European Radiology

, Volume 28, Issue 11, pp 4900–4908 | Cite as

Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans

  • Renato Argirò
  • Daniele DiacintiEmail author
  • Beatrice Sacconi
  • Angelo Iannarelli
  • Davide Diacinti
  • Cristiana Cipriani
  • Daniela Pisani
  • Elisabetta Romagnoli
  • Marco Biffoni
  • Cira Di Gioia
  • Jessica Pepe
  • Mario Bezzi
  • Claudio Letizia
  • Salvatore Minisola
  • Carlo Catalano
Head and Neck



To evaluate the diagnostic performance of 3TMRI in comparison with ultrasound (US) and 99mTc-sestamibi scan for presurgical localisation of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT).


Fifty-seven patients affected by PHPT were prospectively enrolled and underwent US, 99mTc-sestamibi and 3TMRI. T2-weighted and post-contrast T1-weighted Iterative decomposition of water and fat with Echo Asymmetry and Least squares estimation (IDEAL) sequences were acquired. Diagnostic performance of US, 99mTc-sestamibi and MRI in localising PTAs to correct quadrant were compared according to surgical and pathological findings.


According to surgical findings, US correctly localised 41/46 PTAs (sensitivity of 89.1%; specificity 97.5%; PPV 93.1% and NPV 95.6%); 99mTc-sestamibi correctly localised 38/46 PTAs (sensitivity 83.6%, specificity 98.3%, PPV 95% and NPV 93.7%). US and 99mTc-sestamibi combined had a sensitivity of 93.4% (43/46 PTAs), specificity of 98.3%, PPV 95% and NPV 98.3%. MRI correctly localised 45/46 PTAs (sensitivity 97.8%; specificity 97.5%; PPV 93.7% and NPV 99.2%). MRI was able to detect six adenomas missed by 99mTc-sestamibi and two adenomas missed by US. MRI and US were able to detect all enlarged parathyroid glands in patients with multiglandular disease. MRI identified six of seven ectopic adenomas.


Our study demonstrated high diagnostic performance of 3T MRI in the preoperative PTAs quadrant localisation, as well as in patients with multiglandular disease and ectopic PTAs. MRI may be preferred to adequately select patient candidates for minimally invasive parathyroidectomy (MIP).

Key Points

PTA(s) quadrant localisation by 3TMRI was more accurate than US+99mTc-sestamibi.

MRI identified all enlarged glands in multiglandular disease similarly to US.

MRI identified 6/7 ectopic PTAs similarly to 99mTc-sestamibi.

Presurgical PTA(s) localisation by 3TMRI select the optimal candidates for MIP.


Parathyroid adenoma Surgery Magnetic resonance imaging Ultrasonography Scintigraphy 



Confidence interval


Computed tomography


Minimally invasive parathyroidectomy


Magnetic resonance imaging


Primary hyperparathyroidism


Positive predictive value


Parathyroid adenoma(s)


Parathyroid hormone





The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Carlo Catalano

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Ethical approval

Institutional Review Board approval was obtained

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.


• prospective

• observational study

• performed at one institution


  1. 1.
    Press DM, Siperstein AE, Berber E et al (2013) The prevalence of undiagnosed and unrecognised hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery 154:1232–1237CrossRefGoogle Scholar
  2. 2.
    Abboud B, Sleilaty G, Helou E et al (2005) Existence and anatomic distribution of double parathyroid adenoma. Laryngoscope 115:1128–1131CrossRefGoogle Scholar
  3. 3.
    Eigelberger MS, Cheah WK, Ituarte PH et al (2004) The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg 239(4):528–535CrossRefGoogle Scholar
  4. 4.
    Silverberg SJ, Clarke BL, Peacock M et al (2014) Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the fourth international workshop. J Clin Endocrinol Metab 99(10):3580–3594CrossRefGoogle Scholar
  5. 5.
    Bilezikian JP, Brandi ML, Eastell R et al (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 99(10):3561–3569CrossRefGoogle Scholar
  6. 6.
    Howe JR (2000) Minimally invasive parathyroid surgery. Surg Clin North Am 80:1399–1426CrossRefGoogle Scholar
  7. 7.
    Miccoli P, Barellini L, Monchik JM et al (2005) Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy. Br J Surg. 92:814–818CrossRefGoogle Scholar
  8. 8.
    Chen H, Mack E, Starling JR (2005) A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg 242:375–383PubMedPubMedCentralGoogle Scholar
  9. 9.
    Tublin ME, Pryma DA, Yim JH et al (2009) Localization of parathyroid adenomas by sonography and technetium Tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 28(2):183–190CrossRefGoogle Scholar
  10. 10.
    Barczyński M, Cichoń S, Konturek A et al (2006) Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30:721–731CrossRefGoogle Scholar
  11. 11.
    Vignali E, Picone A, Materazzi G et al (2002) A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur J Endocrinol 146:783–788CrossRefGoogle Scholar
  12. 12.
    Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR 188:1706–1715CrossRefGoogle Scholar
  13. 13.
    Phillips CD, Shatzkes DR (2012) Imaging of the parathyroid glands. Semin Ultrasound CT MR 33:123–129CrossRefGoogle Scholar
  14. 14.
    Kunstman JW, Kirsch JD, Mahajan A, Udelsman R (2013) Parathyroid localisation and implications for clinical management. J Clin Endocrinol Metab. 98:902–912CrossRefGoogle Scholar
  15. 15.
    Berczi C, Mezõsi E, Galuska L et al (2002) Technetium-99m-sestamibi/pertechnetate subtraction scintigraphy vs ultrasonography for preoperative localisation in primary hyperparathyroidism. Eur Radiol. 12:605–609CrossRefGoogle Scholar
  16. 16.
    Lumachi F, Zucchetta P, Marzola MC et al (2000) Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localisation: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 143:755–760CrossRefGoogle Scholar
  17. 17.
    van Dalen A, Smit CP, van Vroonhoven TJ (2001) Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology 220:631–639CrossRefGoogle Scholar
  18. 18.
    Lumachi F, Tregnaghi A, Zucchetta P (2004) Technetium-99m sestamibi scintigraphy and helical CT together in patients with primary hyperparathyroidism: a prospective clinical study. Br J Radiol 77:100–103CrossRefGoogle Scholar
  19. 19.
    Rodgers SE, Hunter GJ, Hamberg LM et al (2006) Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 140:932–940CrossRefGoogle Scholar
  20. 20.
    Lopez HE, Vogl TJ, Steinmuller T, Ricke J, Neuhaus P, Felix R (2000) Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism. Invest Radiol 35:426–430CrossRefGoogle Scholar
  21. 21.
    Gotway MB, Reddy GP, Webb WR, Morita ET, Clark OH, Higgins CB (2001) Comparison between MR imaging and 99mTcMIBI scintigraphy in the evaluation of recurrent of persistent hyperparathyroidism. Radiology 218:783–790CrossRefGoogle Scholar
  22. 22.
    Kabala JE (2008) Computed tomography and magnetic resonance imaging in diseases of the thyroid and parathyroid. Eur J Radiol 66:480–492CrossRefGoogle Scholar
  23. 23.
    Barth MM, Smith MP, Pedrosa I (2007) Body MR imaging at 3.0 T: understanding the opportunities and challenges. Radiographics 27:1445–1463CrossRefGoogle Scholar
  24. 24.
    Grayev AM, Gentry LR, Hartman MJ, Chen H, Perlman SB, Reeder SB (2012) Presurgical Localization of parathyroid adenomas with magnetic resonance imaging at 3.0 T: an adjunct method to supplement traditional imaging. Ann Surg Oncol 19:981–989CrossRefGoogle Scholar
  25. 25.
    Sacconi B, Argirò R, Diacinti D et al (2015) MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localisation. Eur Radiol 26:664–673CrossRefGoogle Scholar
  26. 26.
    Israel GM, Hindman N, Hecht E et al (2005) The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR 184:1868–1872CrossRefGoogle Scholar
  27. 27.
    Bahl M, Sepahdari AR, Sosa JA, Hoang JK (2015) Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology 277:454–462CrossRefGoogle Scholar
  28. 28.
    Chazen JL, Gupta A, Dunning A, Phillips CD (2012) Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR 33:429–433CrossRefGoogle Scholar
  29. 29.
    Sho S, Yilma M, Yeh MW et al (2016) Prospective validation of two 4D-CT-based scoring systems for prediction of multigland disease in primary hyperparathyroidism. AJNR 37:2323–2327CrossRefGoogle Scholar
  30. 30.
    Griffith B, Chaudhary H, Mahmood G et al (2015) Accuracy of 2-phase parathyroid CT for the preoperative localization of parathyroid adenomas in primary hyperparathyroidism. AJNR 36:2373–2379CrossRefGoogle Scholar
  31. 31.
    Kluijfhout WP, Pasternak JD, Beninato T et al (2017) Diagnostic performance of computed tomography for parathyroid adenoma localisation; a systematic review and meta-analysis. Eur J Radiol. 88:117–128CrossRefGoogle Scholar
  32. 32.
    Palestro CJ, Tomas MB, Tronco GG (2005) Radionuclide imaging of the parathyroid glands. Semin Nucl Med 35:266–276CrossRefGoogle Scholar
  33. 33.
    Vitetta GM, Neri P, Chiecchio A (2014) Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy. J Ultrasound 17(1):1–12CrossRefGoogle Scholar
  34. 34.
    Erbil Y, Barbaros U, Yanik BT et al (2006) Impact of gland morphology and concomitant thyroid nodules on preoperative localisation of parathyroid adenomas. Laryngoscope 116:580–585CrossRefGoogle Scholar
  35. 35.
    Sugg SL, Krzywda EA, Demeure MJ et al (2004) Detection of multiple gland primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Surgery 136:1303–1309CrossRefGoogle Scholar
  36. 36.
    Kluijfhout WP, Vorselaars WM, Vriens MR, Borel Rinkes IH, Valk GD, de Keizer B (2015) Enabling minimal invasive parathyroidectomy for patients with primary hyperparathyroidism using Tc-99m-sestamibi SPECT-CT, ultrasound and first results of (18)F-fluorocholine PET-CT. Eur J Radiol 84:1745–1751CrossRefGoogle Scholar
  37. 37.
    Michaud L, Balogova S, Burgess A et al (2015) A pilot comparison of 18F-fluorocholine PET/CT, ultrasonography and 123I/99mTc-sestaMIBI dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: influence of thyroid anomalies. Medicine 94(41):e1701CrossRefGoogle Scholar
  38. 38.
    Huber GF, Hüllner M, Schmid C et al (2018) Benefit of 18F-fluorocholine PET imaging in parathyroid surgery. Eur Radiol. CrossRefGoogle Scholar
  39. 39.
    Doppman JL, Hammond WG, Melson GL et al (1969) Staining of parathyroid adenomas by selective arteriography. Radiology 92(3):527–530CrossRefGoogle Scholar
  40. 40.
    Nael K, Hur J, Bauer A et al (2015) Dynamic 4D MRI for characterization of parathyroid adenomas: multiparametric analysis. AJNR 36:2147–2152CrossRefGoogle Scholar
  41. 41.
    Solorzano CC, Carneiro-Pla D (2014) Minimizing cost and maximizing success in the preoperative localisation strategy for primary hyperparathyroidism. Surg Clin North Am. 94:587–605CrossRefGoogle Scholar
  42. 42.
    Lubitz CC, Stephen AE, Hodin RA, Pandharipande P (2012) Preoperative localisation strategies for primary hyperparathyroidism: an economic analysis. Ann Surg Oncol 19:4202–4209CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Renato Argirò
    • 1
    • 2
  • Daniele Diacinti
    • 2
    Email author
  • Beatrice Sacconi
    • 2
    • 3
  • Angelo Iannarelli
    • 2
  • Davide Diacinti
    • 2
  • Cristiana Cipriani
    • 4
  • Daniela Pisani
    • 5
  • Elisabetta Romagnoli
    • 6
  • Marco Biffoni
    • 7
  • Cira Di Gioia
    • 2
  • Jessica Pepe
    • 4
  • Mario Bezzi
    • 2
  • Claudio Letizia
    • 4
  • Salvatore Minisola
    • 4
  • Carlo Catalano
    • 2
  1. 1.Department of Radiology, Interventional Radiology UnitOspedale M.G. Vannini – Figlie di San CamilloRomaItaly
  2. 2.Department of Radiological Sciences, Oncology and PathologySapienza UniversityRomeItaly
  3. 3.Center for Life Nano Science SapienzaIstituto Italiano di TecnologiaRomeItaly
  4. 4.Department of Clinical SciencesSapienza UniversityRomeItaly
  5. 5.Department of Clinical and Molecular MedicineSapienza UniversityRomeItaly
  6. 6.Department of Experimental MedicineSapienza UniversityRomeItaly
  7. 7.Department of Surgery SciencesSapienza UniversityRomeItaly

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