Imaging

Parathyroid Carcinoma

Preliminary Diagnosis: Parathyroid Carcinoma

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound of the thyroid and parathyroid bed

II. Describe the advantages and disadvantages of this technique for diagnosis of parathyroid carcinoma.

Advantages

  • Fast and portable imaging modality

  • Does not expose patients to ionizing radiation

  • May help guided percutaneous intervention

  • Offers exquisite visualization of the surrounding vasculature

Disadvantages

  • Mildly sensitive and poorly specific in diagnosing parathyroid carcinoma

III. What are the contraindications for the first-line imaging technique?

  • No contraindications to ultrasound exist.

IV. What alternative imaging techniques are available?

  • 3-D CT of the parathyroid Bed

  • Nuclear medicine Sestamibi scan

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of parathyroid carcinoma.

3-D CT of the Parathyroid Bed

Advantages

  • Highly sensitive and moderately specific in detailing a parathyroid abnormality

  • Offers exquisite visualization of the surrounding soft tissues, vasculature, and osseous structures

  • Helps guide treatment and therapy

Disadvantages

  • Exposes patients to a large amount of ionizing radiation

Nuclear medicine Sestamibi scan

Advantages

  • Highly sensitive and moderately specific in detailing, characterizing, and diagnosing a parathyroid carcinoma.

Disadvantages

  • Offers limited detail and evaluation of the surrounding soft tissues, osseous structures, and vascular structures

  • Limited in utility in guiding treatment and percutaneous intervention

VI. What are the contraindications for the alternative imaging techniques?

3-D CT of the Parathyroid Bed

  • May be contraindicated in pregnant patients

Nuclear medicine Sestamibi scan

  • May be contraindicated in pregnant patients or those breastfeeding

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