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Nuclear Oncology pp 585–612Cite as

Diagnostic Applications of Nuclear Medicine: Parathyroid Tumors

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Abstract

The most common causes of hyperparathyroidism (HPTH) are of a benign nature, for either primary or secondary HPTH (as well as the tertiary form). Diagnosis of HPTH is based on clinical and biochemical findings, without any role for diagnostic imaging per se. Imaging is instead important for characterizing the disease, regarding especially number and sites of the hyperfunctioning parathyroid glands, which can be in their classical anatomic location or in ectopic locations. This information is crucial for planning surgery with a minimally invasive approach, associated or not with intraoperative guidance with the help of a handheld gamma-detecting probe – an approach that is common to other applications of radioguided surgery.

In addition to high-resolution ultrasound (US) and Magnetic resonance imaging (MRI) (and ceCT for selected applications), SPECT/CT with 99mTc-sestamibi has excellent performance for preoperative imaging of hyperfunctioning parathyroid glands. The PET tracer [11C]methionine has also been shown to possess excellent localization properties in patients with HPTH.

Parathyroid carcinoma is a very rare endocrine malignancy that occurs in <1% of primary HPTH. The initial clinical manifestations of parathyroid carcinoma are primarily linked to the effects of markedly elevated serum PTH levels. At initial presentation, very few patients have metastasis at regional lymph nodes or at distant sites. Parathyroid carcinoma tends to infiltrate adjacent structures in the neck. US, CT, and MRI have been used to localize parathyroid carcinomas and to detect mediastinal and thoracic recurrences or distant metastases. 99mTc-sestamibi scintigraphy can be successful for preoperative localization of the neoplasia and can identify metastases in lymph nodes and at distant sites. PET with [18F]FDG can also detect metastatic parathyroid cancers. Parathyroid carcinoma recurs in more than 50% of the cases and imaging studies should be performed in all patients before reoperation.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-D-glucose

18F-DOPA:

2-18F-Fluoro-L,3,4-dihydroxyphenyilalanine

99mTcO4 - :

99mTc-pertechnetate

ceCT:

Contrast-enhanced computed tomography

CEUS:

Contrast-enhanced ultrasound

CT:

Computed tomography

DW ratio:

Depth/width ratio

EBRT:

External beam radiation therapy

ECG:

Electrocardiogram

HPT-JT:

Hyperparathyroidism-jaw tumor syndrome

HPTH:

Hyperparathyroidism

MEN:

Multiple endocrine neoplasia

MIRP:

Minimally invasive radioguided parathyroidectomy

MRI:

Magnetic resonance imaging

mRNA:

Messenger RNA

PET:

Positron emission tomography

PRAD:

Parathyroid adenomatosis oncogene

PTH:

Parathyroid hormone

RGS:

Radioguided surgery

SPECT:

Single photon emission computed tomography

SPECT/CT:

Single photon emission computed tomography/computed tomography

US:

Ultrasound

VDR:

Vitamin D receptor

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Authors and Affiliations

  1. Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Federica Guidoccio, Sara Mazzarri & Giuliano Mariani

  2. Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy

    Salvatore Mazzeo

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  1. Federica Guidoccio
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  2. Sara Mazzarri
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  3. Salvatore Mazzeo
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  4. Giuliano Mariani
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Correspondence to Giuliano Mariani .

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  1. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    H. William Strauss

  2. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Giuliano Mariani

  3. University of Pisa, Regional Center of Nuclear Medicine, Pisa, Italy

    Duccio Volterrani

  4. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA

    Steven M. Larson

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Guidoccio, F., Mazzarri, S., Mazzeo, S., Mariani, G. (2017). Diagnostic Applications of Nuclear Medicine: Parathyroid Tumors. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-26236-9_40

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