REVIEW  NUCLEAR ENDOCRINOLOGY IN THE ERA OF PRECISION MEDICINE Free access

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2022 June;66(2):93-103

DOI: 10.23736/S1824-4785.22.03427-6

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

An essential practice summary of the new EANM guidelines for parathyroid imaging

Petra PETRANOVIĆ OVČARIČEK ^{1, 2} ✉, Luca GIOVANELLA ^{1, 3, 4}, Elif HINDIE ⁵, Martin W. HUELLNER ⁶, Jean-Noël TALBOT ⁷, Frederik A. VERBURG ^{8, 9}

¹ EANM Thyroid Committee, Vienna, Austria; ² Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; ³ Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland; ⁴ Clinic for Nuclear Medicine and Interdisciplinary Thyroid Center, University Hospital and University of Zurich, Zurich, Switzerland; ⁵ Department of Nuclear Medicine, Bordeaux Hospital and University, Bordeaux, France; ⁶ Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland; ⁷ Nuclear Medicine, Hospital Tenon APHP and Sorbonne University, Paris, France; ⁸ EANM Dosimetry Committee; ⁹ Erasmus MC, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands

Parathyroid imaging is essential for the detection and localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism (pHPT). Surgical treatment of pHPT mainly consists of minimally invasive parathyroidectomy (MIP), as a single adenoma represents the most common cause of this endocrine disorder. Successful surgery requires an experienced surgeon and relies on the correct preoperative detection and localization of hyperfunctioning parathyroid glands. Failure to preoperatively identify the culprit parathyroid gland by imaging may entail a more invasive surgical approach, including bilateral open neck exploration, with higher morbidity compared to minimally invasive parathyroidectomy. Parathyroid imaging may be also useful before surgery in case of secondary hyperparathyroidism (sHPT) or hereditary disorders (MEN 1, 2, 4) as it enables correct localization of typically located parathyroid glands, detection of ectopic as well as supernumerary glands. It is now accepted by most surgeons experienced in parathyroid surgery that preoperative imaging plays a key role in their patients’ management. Recently, the European Association of Nuclear Medicine (EANM) issued an updated version of its Guidelines on parathyroid imaging. Its aim is to precise the role and the advantages and drawbacks of the various imaging modalities proposed or well established in the preoperative imaging strategy. It also aims to favor high performance in indicating, performing, and interpreting those examinations. The objective of the present article is to offer a summary of those recent EANM Guidelines and their originality among other Guidelines in this domain issued by societies of nuclear medicine physicians or other disciplines.

KEY WORDS: Radionuclide imaging; Hyperparathyroidism; Technetium Tc 99m sestamibi; Fluorocholine; Ultrasonography; Four-dimensional computed tomography