Article Figures & Data
Figures
- FIGURE 1.
Ultrasound for hyperfunctioning parathyroid gland. Sagittal (A) and transverse (B) images through thyroid gland reveal mass of uniform echogenicity deep to, and hypoechoic to, thyroid gland.
- FIGURE 2.
SPECT/CT for hyperfunctioning parathyroid gland. 99mTc-sestamibi delayed-washout image reveals focus of intense uptake along posterior margin of cervical trachea (arrow).
- FIGURE 3.
4D CT for hyperfunctioning parathyroid gland. Coronal reformatted image in late enhanced phase reveals rounded enhancing mass within left trachea–esophageal groove. Presence of polar artery (arrow) is specific for parathyroid gland origin.
- FIGURE 4.
Sensitivity of 4D SPECT/CT. A 64-y-old man with PHPT underwent conventional SPECT (A) that showed only physiologic uptake of radiotracer. Corresponding contrast-enhanced CT (B) showed thin enhancing lesion (arrow) in trachea–esophageal groove that was difficult to characterize further. Once attention was drawn to this region by CT findings, 4D SPECT/CT (C) showed uptake associated with CT lesion. Lesion was resected and shown to be parathyroid adenoma, clearly visible only with combined 4D SPECT/CT.
- FIGURE 5.
4D SPECT/CT for multilesional disease. A 53-y-old woman with PHPT had large right-sided parathyroid adenoma on SPECT/CT (A) but no visible uptake in left neck. SPECT images did not identify contralateral lesion, which was seen only on enhanced-CT component (B) of 4D SPECT/CT. Polar artery (arrow) suggested correct diagnosis of multiglandular disease. Hyperparathyroidism was cured with single bilateral surgery.
- FIGURE 6.
Patient flowchart for preoperative imaging of primary hyperparathyroidism. All patients underwent ultrasound. Worrisome clinical and sonographic parameters (obesity, previous failed parathyroid surgery, multinodular thyroid) prompted use of 4D SPECT/CT. Otherwise, traditional SPECT/CT was performed. But if traditional SPECT/CT failed to identify lesion, then 4D SPECT/CT was used during same patient visit.
