Endocrine Surgery

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Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

Konstantin Y. Slashchuk, Michail V. Degtyarev, Pavel O. Rumyantsev, Ekaterina A. Troshina, Galina A. Melnichenko

https://doi.org/10.14341/serg12241

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Abstract

Primary hyperparathyroidism (PHPT) is a common endocrine disease that occurs with multiple profiles in which no classical manifestation. Diagnosis revolves around routine measurement of serum calcium and parathyroid hormone more than in half cases. The understanding of clinical presentation, epidemiology and management tactics of patients with hyperparathyroidism has significantly changed by virtue of the use of biochemical calcium screening.

The successful diagnosis and treatment are possible with the cooperation of a multidisciplinary team of endocrinologist, endocrine surgeon, radiologist, nuclear medicine physician and pathomorphologist.

The only radical method of treatment is the surgical removal of abnormal parathyroid glands. In this regard, there is necessary to improve the parathyroid glands imaging algorithms.

Early treatment of hyperparathyroidism allows to avoid severe damage to the bones, kidneys, heart, other organs, improving the quality of life and reducing the incidence of disability.

For a systematic literature review, more than 100 articles published from 2000 to the present time were used, on following resources: PubMed, Embase, SciSearch, Scopus, Cochrane Databases, Research Gate, Google Scholar. Including recommendations from the American Association of Endocrinologists and Endocrine Surgeons (AACE/AAES), European Society of Nuclear Medicine (EANM), European Society of Endocrinologists (ESE), Russian Association of Endocrinologists (RAE) and several other organizations.

The main goal of this review is to summarize and present relevant information and a new look on preoperative imaging techniques, methods of intraoperative navigation, surgery, control quality of treatment in patients with primary hyperparathyroidism.

Keywords

hyperparathyroidism, imaging techniques, ultrasound, scintigraphy, SPECT, SPECT/CT, CT, MRI, PET, PET/CT, nuclear medicine, endocrine surgery, endocrinology

About the Authors

Konstantin Y. Slashchuk

Endocrinology Research Centre
Russian Federation

MD

Michail V. Degtyarev

Endocrinology Research Centre
Russian Federation

MD

Pavel O. Rumyantsev

Endocrinology Research Centre
Russian Federation

MD, PhD

Ekaterina A. Troshina

Endocrinology Research Centre
Russian Federation

MD, PhD, professor, corresponding member of the RAS

Galina A. Melnichenko

Endocrinology Research Centre
Russian Federation

MD, PhD, Professor

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Supplementary files

	1. Схема закладки и пути миграции ОЩЖ
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	2. Fig. 1. Scheme bookmarks and migration pathway.
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	3. Fig. 2. a - ultrasound, with a longitudinally located sensor hypoechoic formation (thin arrow) behind the left lobe of the thyroid gland (thick arrow); b - in the color Doppler mode, hypoechoic formation of the thyroid gland (thin arrow) with typically enhanced vascularization at one of the poles (thick arrow) (images from Diagnostic Imaging: head and neck, 3rd edition, Elsevier 2017).
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	4. Fig. 3. a - the formation of the thyroid gland (arrow); b - with increased blood flow after intravenous administration of ultrasound contrast SonoVue (arrow) (images Soldatova T.V., Research Center for Endocrinology).
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	5. Fig. 4. On the left - the formation of the thyroid gland, suspicious of malignancy (> 3 cm, heterogeneous, irregular in shape with uneven edges); on the right - intensively blood supply during Doppler ultrasound imaging (images of Zakharova S.M., Research Center for Endocrinology).
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	6. Fig. 5. Two-phase scintigraphy. An early and delayed scan with 99mTc-MIBI, the formation of the thyroid gland in the projection of the right lobe of the thyroid gland (arrows) is visualized, preserving the increased capture of the radiopharmaceutical (images of M. Degtyarev, Research Center for Endocrinology).
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	7. Fig. 6. Two-isotope scintigraphy. On the left - 99mTc-MIBI, formation with increased accumulation of radiopharmaceuticals is visualized downward from the lower pole of the right lobe of the thyroid gland (circle); on the right - 99mTc-pertechnetate, there is no accumulation of radiopharmaceuticals in this projection (circle) (images of Degtyarev MV, Research Center for Endocrinology).
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	8. Fig. 7. SPECT / CT with 99mTc-MIBI, the formation of the thyroid gland behind and down from the lower pole of the left lobe of the thyroid gland (arrow), accumulating radiopharmaceuticals (images of MV Degtyarev, Research Center for Endocrinology).
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	9. Fig. 8. a - CT axial section with contrast, formation (thin arrow) behind the left lobe of the thyroid gland (thick arrow) in the tracheoesophageal sulcus, slightly less contacted in the delayed image; b - sagittal section, heterogeneous oval formation (thin arrows) behind the left lobe of the thyroid gland (thick arrow) (images from Diagnostic Imaging: head and neck, 3rd edition, Elsevier 2017).
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	10. Fig. 9. Axial sections of CT with contrast; a - a typical picture of an artery (thin arrow) that supplies blood to the formation of the thyroid gland (thick arrow); b - the active formation of contrast-active thyroid gland, which, however, was poorly visualized in the delayed (venous) phase, almost corresponded in density to the esophagus (images from Diagnostic Imaging: head and neck, 3rd edition, Elsevier 2017).
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	11. Fig. 10. Axial section of MRI in T2WI, an oval formation (arrows) was noted, which has a high signal intensity compared to the thyroid gland or lymph nodes (images from Diagnostic Imaging: head and neck, 3rd edition, Elsevier 2017).
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	12. Fig. 11. Intraoperative images of the thyroid gland (arrows); a, b, c - unvascularized thyroid in the visible, infrared and green spectra; d, f, f — intensively supplied blood to the thyroid gland in the visible, infrared, and green spectra (images from [106]).
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	13. Fig. 12.1. Top: surgical field in camera light;
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	14. Fig. 12.2. Bottom: a - left lobe of the thyroid gland before discharge; b - image in the infrared spectrum of the same fraction of the thyroid gland and the thyroid gland (arrow); c - image of the lobe after isolation of the thyroid gland (arrow) (images from [107]).
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Review

For citations:

Slashchuk K.Y., Degtyarev M.V., Rumyantsev P.O., Troshina E.A., Melnichenko G.A. Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review. Endocrine Surgery. 2019;13(4):153-174. (In Russ.) https://doi.org/10.14341/serg12241

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