Parathyroid Case 2 Answers

1) Any evidence of a parathyroid abnormality?

Yes, there is abnormal uptake superior to the thyroid isthmus on the MIBI images but not on the thyroid images, consistent with an adenoma

2) What are A+B?

A is the submandibular salivary gland and B is the parotid gland. MIBI is taken up into all organs in a passive fashion (similar to thallium and to a lesser extent, gallium). Uptake is dependent on their blood flow, which in turn depends on their metabolic rate. Salivary glands are very metabolically active and therefore show intense uptake.

3) Is there any role for performing parathyroid scintigraphy in patients where the diagnosis of hyperparathyroidism is in some doubt?

The use of scintigraphy in helping diagnose hyperparathyroidism is on the decline due to its lack of sensitivity, advent of accurate assays for parathormone (PTH) and worries about excessive radiation dose. The key to accurate diagnosis is raised PTH level in a patient with hypercalcaemia.

The major role for parathyroid scintigraphy is now for pre-operative localization of possible adenomas for the surgeon. Most hyperparathyroidism (85%) is due to a single adenoma. Many surgeons find such localization very useful as it limits the amount of necessary neck dissection. This is particularly true in ectopic glands or recurrent disease where there may be scarring from previous surgery.

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The text is entirely the opinion of the author and does not necessarily reflect that of RUH NHS Trust or the Bristol Radiology Training Scheme. Website content devised by Paul McCoubrie.