The EANM practice guidelines for parathyroid imaging

• Published in: European journal of nuclear medicine and molecular imaging Vol. 48; no. 9; pp. 2801 - 2822
• Main Authors: Petranović Ovčariček, Petra, Giovanella, Luca, Carrió Gasset, Ignasi, Hindié, Elif, Huellner, Martin W., Luster, Markus, Piccardo, Arnoldo, Weber, Theresia, Talbot, Jean-Noël, Verburg, Frederik Anton
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.08.2021; Springer Nature B.V; Springer Verlag (Germany) [1976-....]
• Subjects: Adenoma; Cardiology; Clinical practice guidelines; Computed tomography; Emission analysis; Endocrinology; Guidelines; Hyperparathyroidism; Imaging; Life Sciences; Localization; Magnetic resonance imaging; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Oncology; Orthopedics; Parathyroid; Parathyroid gland; Parathyroidectomy; Photon emission; Physicians; Positron emission; Positron emission tomography; Radioisotopes; Radiology; Scintigraphy; Single photon emission computed tomography; Surgery; Tomography; C]CH; Dual-tracer scintigraphy; Tc]Tc-MIBI; MRI; Tc]Tc-tetrofosmin; SPECT/CT; Dual-phase scintigraphy; 4D-CT; Cervical ultrasonography; PET/CT; C]MET; F-labeled choline analogues; [; Parathyroid scintigraphy; Hyperparathyroidism; [99mTc]Tc-MIBI; [11C]MET; [99mTc]Tc-tetrofosmin; [11C]CH; 18F-labeled choline analogues
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-021-05334-y

Introduction Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration. Methods Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT. Conclusion These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.