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Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review
by
Nivedita Chakrabarty
Nivedita Chakrabarty 1
,
Abhishek Mahajan
Abhishek Mahajan
Abhishek Mahajan is a Consultant Radiologist at the Clatterbridge Cancer Centre. He obtained his at [...]
Abhishek Mahajan is a Consultant Radiologist at the Clatterbridge Cancer Centre. He obtained his M.D. at the Kasturba Medical College, Manipal. He received his Masters in Translational Cancer Medicine from King’s College London from 2013 to 2014. He was a Cancer Imaging Fellow at Asia’s leading cancer hospital and teaching Institute, the Tata Memorial Hospital (TMH), Mumbai, from 2009 to 2011. He joined the faculty at the Tata Memorial Centre, Mumbai, and served until 2022 as Professor of Radiology and Consultant radiologist. He is a member of the International Society for Magnetic Resonance in Medicine, the Radiological Society of North America, the European Society of Radiology, and American Roentgen Ray Society (ARRS). He is also a member of the European Society for Hybrid Medical Imaging, the European Society of Oncological Imaging, the American Association for Cancer Research, and Asia-Pacific Society of Thyroid Surgery (APTS).
2,3,*
,
Sandip Basu
Sandip Basu 4 and
Anil K. D’Cruz
Anil K. D’Cruz 5,6,7
1
Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India
2
Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
3
Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
4
Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India
5
Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India
6
Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
7
Union International Cancer Control (UICC), 1202 Geneva, Switzerland
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(14), 2593; https://doi.org/10.3390/cancers16142593 (registering DOI)
Submission received: 28 May 2024
/
Revised: 6 July 2024
/
Accepted: 17 July 2024
/
Published: 19 July 2024
Simple Summary
Parathyroid glands are four in number and usually located adjacent to the thyroid gland, however, variations in location and number can exist. Parathyroid glands produce and release parathyroid hormone (PTH) important for maintaining blood calcium levels. In primary hyperparathyroidism (PHPT), there is increased secretion of PTH with resultant elevated blood calcium levels due to causes within the parathyroid gland, such as a single or multiple tumours which could be benign or malignant. The role of imaging is to locate abnormal parathyroid gland including its presence in unusual location if any, localise tumour within the parathyroid gland and plan surgical approach. Additional role of imaging in a suspected case of parathyroid malignancy is to look for any distant spread. There is emerging evidence to suggest that incidental detection of enlarged parathyroid glands on routine CT by the radiologist, can lead to early diagnosis of PHPT before obvious symptoms and signs develop. In this article, we have described the various imaging modalites available for evaluation of various types of parathyroid tumours, along with their imaging appearances and advantages and disadvantages. In addition, we have prepared a flowchart for guiding management decisions for parathyroid tumours.
Abstract
Parathyroid pathologies are suspected based on the biochemical alterations and clinical manifestations, and the predominant roles of imaging in primary hyperparathyroidism are localisation of tumour within parathyroid glands, surgical planning, and to look for any ectopic parathyroid tissue in the setting of recurrent disease. This article provides a comprehensive review of embryology and anatomical variations of parathyroid glands and their clinical relevance, surgical anatomy of parathyroid glands, differentiation between multiglandular parathyroid disease, solitary adenoma, atypical parathyroid tumour, and parathyroid carcinoma. The roles, advantages and limitations of ultrasound, four-dimensional computed tomography (4DCT), radiolabelled technetium-99 (99mTc) sestamibi or dual tracer 99mTc pertechnetate and 99mTc-sestamibi with or without single photon emission computed tomography (SPECT) or SPECT/CT, dynamic enhanced magnetic resonance imaging (4DMRI), and fluoro-choline positron emission tomography (18F-FCH PET) or [11C] Methionine (11C -MET) PET in the management of parathyroid lesions have been extensively discussed in this article. The role of fluorodeoxyglucose PET (FDG-PET) has also been elucidated in this article. Management guidelines for parathyroid carcinoma proposed by the American Society of Clinical Oncology (ASCO) have also been described. An algorithm for management of parathyroid lesions has been provided at the end to serve as a quick reference guide for radiologists, clinicians and surgeons.
Share and Cite
MDPI and ACS Style
Chakrabarty, N.; Mahajan, A.; Basu, S.; D’Cruz, A.K.
Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review. Cancers 2024, 16, 2593.
https://doi.org/10.3390/cancers16142593
AMA Style
Chakrabarty N, Mahajan A, Basu S, D’Cruz AK.
Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review. Cancers. 2024; 16(14):2593.
https://doi.org/10.3390/cancers16142593
Chicago/Turabian Style
Chakrabarty, Nivedita, Abhishek Mahajan, Sandip Basu, and Anil K. D’Cruz.
2024. "Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review" Cancers 16, no. 14: 2593.
https://doi.org/10.3390/cancers16142593
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