Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review

Abstract

Background: Thyroid disease occurs more frequently in patients with hyperparathyroidism than the general population and hinders parathyroid localization. Identifying thyroid pathology before operating improves management and avoids the risks of reoperation in the neck. This review assesses imaging studies in patients with hyperparathyroidism and thyroid pathology to identify the ideal imaging methodology for patients with multigland disease. Methods: Systematic review of original articles reporting sensitivity or positive predictive value (PPV) for one or more imaging modalities in patients with hyperparathyroidism and thyroid disease. Results: Twenty-eight studies, 13 prospective and 15 retrospective, met inclusion criteria. Nine modalities were evaluated, including: cervical ultrasound (n = 18), dual-phase 99m Tc-sestamibi (n = 14), subtraction scintigraphy (n = 11), combined ultrasound and scintigraphy (n = 8), single photon emission CT (SPECT; n = 5), SPECT-CT (n = 4), contrast-enhanced ultrasound (n = 1), CT (n = 1), and MRI (n = 1). Conclusion: Combined ultrasound and scintigraphy is the most sensitive study to localize parathyroid adenomas in patients with hyperparathyroidism and thyroid disease, followed by hybrid SPECT-CT and SPECT.