Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review)
Patients diagnosed with multiple endocrine neoplasia type-1 (MEN1) often initially present with primary hyperparathyroidism (pHPT), and typically undergo surgical intervention. While laboratory tests are fundamental for diagnosis, imaging is crucial for localizing pathological parathyroids to aid in...
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2024-12-01
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| author | Valentina Berti Francesco Mungai Paolo Lucibello Maria Luisa Brandi Carlo Biagini Alessio Imperiale |
| author_facet | Valentina Berti Francesco Mungai Paolo Lucibello Maria Luisa Brandi Carlo Biagini Alessio Imperiale |
| author_sort | Valentina Berti |
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| description | Patients diagnosed with multiple endocrine neoplasia type-1 (MEN1) often initially present with primary hyperparathyroidism (pHPT), and typically undergo surgical intervention. While laboratory tests are fundamental for diagnosis, imaging is crucial for localizing pathological parathyroids to aid in precise surgical planning. In this pictorial review, we will begin by comprehensively examining key imaging techniques and their established protocols, evaluating their effectiveness in detecting abnormal parathyroid glands. This analysis will emphasize both the advantages and potential limitations within the clinical context of MEN1 patients. Additionally, we will explore integrated imaging approaches that combine multiple modalities to enhance localization accuracy and optimize surgical planning—an essential component of holistic management in MEN1 cases. Various imaging techniques are employed for presurgical localization, including ultrasound (US), multiphase parathyroid computed tomography (CT) scanning (4D CT), magnetic resonance imaging (MRI), and nuclear medicine techniques like single photon emission computed tomography/CT (SPECT/CT) and positron emission tomography/CT (PET/CT). US is non-invasive, readily available, and provides high spatial resolution. However, it is operator-dependent and may have limitations in certain cases, such as intrathyroidal locations, the presence of bulky goiters, thyroid nodules, and previous thyroidectomy. Four-dimensional CT offers dynamic imaging, aiding in the identification of enlarged parathyroid glands, particularly in cases of ectopic or supernumerary glands. Despite concerns about radiation exposure, efforts are underway to optimize protocols and reduce doses, including the use of dual-energy CT. MR imaging offers excellent soft tissue contrast without radiation exposure, potentially providing superior differentiation between parathyroid glands and the surrounding structures. Radionuclide imaging, especially PET/CT using radiopharmaceuticals like [<sup>18</sup>F]FCH, shows promising results in localizing parathyroid tumors, particularly in patients with MEN1. [<sup>18</sup>F]FCH PET/CT demonstrates high sensitivity and may provide additional information compared to other imaging modalities, especially in cases of recurrent HPT. |
| format | Article |
| id | doaj-art-35e129e7b8ca4e739ccef8607756d09f |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
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| series | Diagnostics |
| spelling | doaj-art-35e129e7b8ca4e739ccef8607756d09f2025-01-10T13:16:26ZengMDPI AGDiagnostics2075-44182024-12-011511110.3390/diagnostics15010011Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review)Valentina Berti0Francesco Mungai1Paolo Lucibello2Maria Luisa Brandi3Carlo Biagini4Alessio Imperiale5Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, ItalyRadiology Unit, Careggi University Hospital, 50134 Florence, ItalyDonatello Bone Clinic, Sesto Fiorentino, 50134 Florence, ItalyDepartment of Endocrinology, University Vita-Salute San Raffaele, 20132 Milan, ItalyDonatello Bone Clinic, Sesto Fiorentino, 50134 Florence, ItalyDepartment of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), University Hospitals of Strasbourg, University of Strasbourg, 67200 Strasbourg, FrancePatients diagnosed with multiple endocrine neoplasia type-1 (MEN1) often initially present with primary hyperparathyroidism (pHPT), and typically undergo surgical intervention. While laboratory tests are fundamental for diagnosis, imaging is crucial for localizing pathological parathyroids to aid in precise surgical planning. In this pictorial review, we will begin by comprehensively examining key imaging techniques and their established protocols, evaluating their effectiveness in detecting abnormal parathyroid glands. This analysis will emphasize both the advantages and potential limitations within the clinical context of MEN1 patients. Additionally, we will explore integrated imaging approaches that combine multiple modalities to enhance localization accuracy and optimize surgical planning—an essential component of holistic management in MEN1 cases. Various imaging techniques are employed for presurgical localization, including ultrasound (US), multiphase parathyroid computed tomography (CT) scanning (4D CT), magnetic resonance imaging (MRI), and nuclear medicine techniques like single photon emission computed tomography/CT (SPECT/CT) and positron emission tomography/CT (PET/CT). US is non-invasive, readily available, and provides high spatial resolution. However, it is operator-dependent and may have limitations in certain cases, such as intrathyroidal locations, the presence of bulky goiters, thyroid nodules, and previous thyroidectomy. Four-dimensional CT offers dynamic imaging, aiding in the identification of enlarged parathyroid glands, particularly in cases of ectopic or supernumerary glands. Despite concerns about radiation exposure, efforts are underway to optimize protocols and reduce doses, including the use of dual-energy CT. MR imaging offers excellent soft tissue contrast without radiation exposure, potentially providing superior differentiation between parathyroid glands and the surrounding structures. Radionuclide imaging, especially PET/CT using radiopharmaceuticals like [<sup>18</sup>F]FCH, shows promising results in localizing parathyroid tumors, particularly in patients with MEN1. [<sup>18</sup>F]FCH PET/CT demonstrates high sensitivity and may provide additional information compared to other imaging modalities, especially in cases of recurrent HPT.https://www.mdpi.com/2075-4418/15/1/11MEN1hyperparathyroidismparathyroid tumorsparathyroid imagingultrasoundcomputed tomography |
| spellingShingle | Valentina Berti Francesco Mungai Paolo Lucibello Maria Luisa Brandi Carlo Biagini Alessio Imperiale Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review) Diagnostics MEN1 hyperparathyroidism parathyroid tumors parathyroid imaging ultrasound computed tomography |
| title | Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review) |
| title_full | Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review) |
| title_fullStr | Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review) |
| title_full_unstemmed | Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review) |
| title_short | Up-to-Date Imaging for Parathyroid Tumor Localization in MEN1 Patients with Primary Hyperparathyroidism: When and Which Ones (A Narrative Pictorial Review) |
| title_sort | up to date imaging for parathyroid tumor localization in men1 patients with primary hyperparathyroidism when and which ones a narrative pictorial review |
| topic | MEN1 hyperparathyroidism parathyroid tumors parathyroid imaging ultrasound computed tomography |
| url | https://www.mdpi.com/2075-4418/15/1/11 |
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