Parathyroid Imaging: Four-dimensional Computed Tomography, Sestamibi, and Ultrasonography

Multiple modalities exist for evaluation of PHPT, with various advantages in terms of sensitivity, cost-effectiveness, and radiation exposure. Familiarity with limitations of each approach can help formulate a diagnostic approach, particularly in the setting of multiglandular disease, variant anatomy, and the previously operated neck. Knowledge of normal parathyroid anatomy as well as expected locations for ectopic parathyroid location can aid in successful preoperative imaging evaluation for parathyroid adenoma and parathyroid hyperplasia, regardless of technique. Successful preoperative localization of candidate parathyroid tissue supports minimally invasive techniques and avoids the potentially more morbid 4-gland exploration.