Parathyroid Imaging

This comprehensive book explores the advantages and limitations of various imaging modalities used in the preoperative assessment of hyperfunctioning parathyroid glands, while also covering surgical and histopathological aspects of parathyroid disorders.

It delves into the technical details of each imaging technique, evaluates their accuracy in diverse clinical settings, provides comparative analyses, and discusses their cost-effectiveness. Parathyroid imaging is crucial for detecting hyperfunctioning parathyroid glands, especially in cases of primary hyperparathyroidism. Accurate localization of parathyroid glands is essential for successful surgical intervention. Minimally invasive parathyroidectomy, which is the only curative treatment for primary hyperparathyroidism, offers numerous advantages over traditional bilateral neck exploration. However, the success of this approach heavily relies on both the surgeon's expertise and, particularly, on accurate preoperative imaging. 

The book also highlights the importance of parathyroid imaging in secondary hyperparathyroidism, aiding in the localization of all hyperfunctioning glands, including ectopic and supernumerary glands. Parathyroid imaging is indispensable in cases of persistent or recurrent hyperparathyroidism, as a repeat surgery is often more complex than the initial procedure, making the identification of hyperfunctioning glands critical for a positive outcome. 

In addition to well-established imaging methods such as ultrasound and traditional scintigraphy, newer technologies such as 4D-CT, MRI, PET/CT and PET/MR with various radiopharmaceuticals have significantly improved the accuracy of parathyroid gland localization, leading to improved outcomes for many patients. The selection of the imaging modality depends on factors such as accuracy, local expertise, patient-specific characteristics, availability and cost-effectiveness.

This book serves as a valuable resource for nuclear medicine physicians, endocrinologists, radiologists, endocrine surgeons, and pathologists, encouraging a multidisciplinary approach to parathyroid gland disorders.

Petra Petranović Ovčariček is an experienced nuclear medicine physician practicing at the University Hospital Center Sestre Milosrdnice in Zagreb, Croatia, with specialized expertise in thyroid and parathyroid disease diagnostics. She served as a member of the EANM Thyroid Committee from 2019-2024 and has been their guidelines representative since 2021. She is the lead author of the EANM practice guidelines for parathyroid imaging.

Luca Giovanella is an experienced and well-established nuclear medicine physician and endocrinologist. He leads the nuclear medicine department and the thyroid and parathyroid clinical unit in Clinica Moncucco, Lugano, Switzerland, and serves as a professor of nuclear medicine at the University of Zurich, Switzerland. He has been the Deputy Chair (2014-2020) and the Chair of the EANM Thyroid Committee since 2021. He is the author of more than 500 peer-reviewed papers, especially dedicated to thyroid disease. He is one of the co-authors of the EANM practice guidelines for parathyroid imaging.

Martin W. Huellner is an experienced, board-certified nuclear medicine physician, radiologist, and neuroradiologist at the University Hospital Zurich, Switzerland. His expertise focuses on imaging for parathyroid diseases, head and neck tumors, brain tumors and neurodegeneration. Alongside Luca Giovanella and Petra Petranović Ovčariček, he co-authored the EANM practice guidelines for parathyroid imaging.