MRI findings and utility of DWI in the evaluation of solid parathyroid lesions

  • Seyma YildizEmail author
  • Ayse Aralasmak
  • Huseyin Yetis
  • Rukiye Kilicarslan
  • Rasul Sharifov
  • Alpay Alkan
  • Huseyin Toprak



To evaluate the MRI findings of solid parathyroid lesions and to elaborate on a possible improvement of MRI detection of parathyroid lesions by the use of additional DWI.

Materials and methods

MRI and DWI properties of pathologically proven 20 solid parathyroid lesions were retrospectively reviewed. Mean ADC values (b50 + b400 + b800/3) of parathyroid lesions were compared with that of normal appearing thyroid parenchyma (TP), sternocleidomastoid muscle (SCM) and jugulodigastric lymph nodes (JDLN).


Of lesions, 4 were parathyroid hyperplasia, 13 parathyroid adenoma and 3 parathyroid adenocarcinoma. All parathyroid lesions were very bright on fat-saturated T2W images. Parathyroid hyperplasia and adenoma were small sized, homogenous, well-defined and low on T1W, high on T2W and avidly enhancing. Parathyroid carcinoma was large sized, ill-defined and very heterogeneous on MRI including DWI. Means ADC values of parathyroid hyperplasia, adenoma, and adenocarcinoma, TP, SCM and JDLN were measured as 2.3 ± 0.14 × 10−3, 1.7 ± 0.45 × 10−3, 1.5 ± 1.48 × 10−3, 0.87 ± 0.40 × 10−3, 0.55 ± 0.21 × 10−3 and 0.96 ± 0.33 × 10−3 mm2/s, respectively. All parathyroid lesions had high diffusion properties comparing other soft tissue structures of head and neck region. By increasing strength (b value) of diffusion tensor on DWI, solid parathyroid lesions still kept their brightness comparing other soft tissue structures of head and neck region because of their high T2 properties.


Solid parathyroid lesions had higher diffusion properties comparing other soft tissues structures of head and neck region. This feature makes them easily differentiate from nearby structures on fat-saturated T2W and DWI.


Parathyroid MRI DWI Solid parathyroid lesions MRI findings solid parathyroid lesions DWI of solid parathyroid lesions 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Our studies is retrospective. For this type of study, formal consent is not required.

Ethical standards

This article does not contain any studies with animals performed by any of the authors.


  1. 1.
    Johnson NA, Tublin ME, Ogilvie JG (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR 188:1706–1715CrossRefGoogle Scholar
  2. 2.
    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 or persistent hyperparathyroidism. Radiology 218:783–790CrossRefGoogle Scholar
  3. 3.
    Phillips CD, Shatzkes DR (2012) Imaging of the parathyroid glands glands. Semin Ultrasound CT MR. 33(2):123–129CrossRefGoogle Scholar
  4. 4.
    Higgins CB, Auffermann W (1998) MR imaging of thyroid and parathyroid glands: a review of current status. AJR 151:1095–1106CrossRefGoogle Scholar
  5. 5.
    Martínez Barbero JP, Rodríquez Jiménez I, Martin Noguerol T et al (2013) Utility of MRI diffusion techniques in the evaluation of tumors of the head and neck. Cancers (Basel) 5:875–889CrossRefGoogle Scholar
  6. 6.
    Numerow LM, Morita ET, Clark OH, Higgins CB (1995) Persistent/recurrent hyperparathyroidism: a comparison of sestamibi scintigraphy, MRI, and ultrasonography. J Magn Reson Imaging 5:702–708CrossRefGoogle Scholar
  7. 7.
    Ishibashi M, Nishida H, Hiromatsu Y, Kojima K, Tabuchi E, Hayubuchi N (1998) Com-parison of technetium-99m-MIBI, technetium-99m-tetrofosmin, ultrasound and MRI for localization of abnormal parathyroid glands. J Nucl Med 39:320–324PubMedGoogle Scholar
  8. 8.
    De Feo ML, Colagrande S, Biagini C et al (2000) Parathyroid glands: combination of (99 m)Tc MIBI scintigraphy and US for demonstration of parathyroid glands and nodules. Radiology 214:393–402CrossRefGoogle Scholar
  9. 9.
    Moinuddin M, Whynott C (1996) Ectopic parathyroid adenomas: multiimaging modalities and its management. Clin Nucl Med 21:27–32CrossRefGoogle Scholar
  10. 10.
    Summers GW (1996) Parathyroid update: a review of 220 cases. Ear Nose Throat J 75:434–439PubMedGoogle Scholar
  11. 11.
    Peeler BB, Martin WH, Sandler MP, Goldstein RE (1997) Sestamibi parathyroid scanning and preoperative localization studies for patients with recurrent/persistent hyperparathyroidism or significant comorbid conditions: development of an optimal localization strategy. Am Surg 63:37–46PubMedGoogle Scholar
  12. 12.
    Lee JH, Anzai Y (2013) Imaging of thyroid and parathyroid glands. Semin Roentgenol 48:87–104CrossRefGoogle Scholar
  13. 13.
    Bilezikian JP, Khan AA, Potts JT (2009) Hyperthyroidism TIWotMoAP. Guidelines for the management of asymptomatic primary hyperpara-thyroidism: summary statement from the third international work-shop. J Clin Endocrinol Metab 94:335–339CrossRefGoogle Scholar
  14. 14.
    Beland MD, Mayo-Smith WW, Grand DJ et al (2011) Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with pri-mary hyperparathyroidism. Am J Roentgenol 196:61–65CrossRefGoogle Scholar
  15. 15.
    Gafton AR, Glastonbury CM, Eastwood JD et al (2012) Parathyroid lesions: characterization with dual-phase arterial and venous enhanced CT of the neck. AJNR 33:949–952CrossRefGoogle Scholar
  16. 16.
    Mortenson MM, Evans DB, Lee JE et al (2008) Parathyroid exploration in thereoperative neck: improved preoperative localization with 4D computed tomography. J Am Coll Surg 206:888–895CrossRefGoogle Scholar
  17. 17.
    Hindié E, Ugur O, Fuster D et al (2009) EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging 36:1201–1216CrossRefGoogle Scholar
  18. 18.
    Slater A, Gleeson FV (2005) Increased sensitivity and confidence of SPECT over planar imaging in dual-phase sestamibi for parathyroid adenoma detection. Clin Nucl Med 30(1):1–3CrossRefGoogle Scholar
  19. 19.
    Bajoghli M, Muthukrishnan A, Mountz JM (2006) Posterior bulge sign for parathyroid adenoma on Tc-99m MIBI SPECT. Clin Nucl Med 31(8):470–471CrossRefGoogle Scholar
  20. 20.
    Nael K, Hur J, Bauer A et al (2015) Dynamic 4D MRI for characterization of parathyroid adenomas: multiparametric analysis. AJNR 36(11):2147–2152CrossRefGoogle Scholar
  21. 21.
    Johnson NA, Carty SE, Tublin ME (2011) Parathyroid imaging. Radiol Clin N Am 49(3):489–509CrossRefGoogle Scholar
  22. 22.
    Yusim A, Aspelund G, Ahrens W et al (2006) Intrathyroidal parathyroid adenoma. Thyroid 16(6):619–620CrossRefGoogle Scholar
  23. 23.
    Taouli B, Thakur RK, Mannelli L et al (2009) Renal lesions: characterization with diffusion-weighted imaging versus contrast-enhanced MR imaging. Radiology 251:398–407CrossRefGoogle Scholar
  24. 24.
    Aschenbach R, Tuda S, Lamster E et al (2012) Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck. Eur J Radiol 81:3371–3377CrossRefGoogle Scholar
  25. 25.
    Pellittery PK (2010) Management of parathyroid disorders. In: Flint PW, Cummings CW (eds) Cummings otolaryngology head and neck surgery, 5th edn. Mosby/Elsevier, PhiladelphiaGoogle Scholar
  26. 26.
    Bondeson L, Sandelin K, Grimelius L (1993) Histopathological variables and DNA cytometry in parathyroid carcinoma. Am J Surg Pathol 17:820–829CrossRefGoogle Scholar
  27. 27.
    Naganawa S, Sato C, Nakamura T et al (2005) Diffusion-weighted images of the liver: comparison of tumor detection before and after contrast enhancement with superparamagnetic iron oxide. J Magn Reson Imaging 21:836–840CrossRefGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  1. 1.Department of RadiologyBezmialem Vakif UniversityIstanbulTurkey

Personalised recommendations