Once a diagnosis of hyperparathyroidism has been made, parathyroid imaging is used to try and localize the parathyroid tumor.
Parathyroid imaging should not be used to decide if you should have surgery, nor does it play any role in the diagnosis. Its only purpose is to help the surgeon plan for parathyroid surgery.
Surgeon-performed ultrasound is the first imaging test that should be used to localize an abnormal parathyroid gland. However, ultrasound only discovers an abnormal gland 50-60% of the time and therefore many patients need a second, more sensitive imaging test to find the abnormal gland(s).
Dr. Goldfarb performs her own parathyroid ultrasound in clinic on all patients referred for hyperparathyroidism; it is an integral part of the consultation and simply an extension of the physical exam. As a surgeon, her overall experience and understanding of the disease process, both in and out of the operating room, allows her to uniquely evaluate for parathyroid tumors or thyroid abnormalities on ultrasound and create a personalized plan at the time of the visit.
All ultrasound images will be reviewed with you in real time.
3D/4D Parathyroid CT is the newest, most up-to-date technology to help locate abnormal parathyroid glands.
Parathyroid CT is currently the most cost-effective, sensitive, specific, and time-efficient imaging test for parathyroid localization. The name of the technique comes from adding a dimension of time to a normal CT scan to look at changes over time in the perfusion of IV-contrast through a parathyroid gland. A CT scan visualizes anatomic locations that an ultrasound cannot see, allowing this special protocol to produce very detailed anatomical of the neck and functional information on abnormal parathyroid gland(s). Here at Saint John’s we use a lower-radiation, 3D protocol to minimize the amount of radiation for patients.
The sestamibi scan used to be the gold standard of parathyroid imaging. It is a nuclear medicine test where you are given a small amount of tracer through an IV and serial pictures are taken of your neck over a couple hour period. The test only detects an abnormal parathyroid gland about 60% of the time, and can give false positives in anyone that has thyroid nodules or Hashimotos thyroiditis.