2009 EANM parathyroid guidelines

  • Elif Hindié
  • Ömer Ugur
  • David Fuster
  • Michael ODoherty
  • Gaia Grassetto
  • Pablo Ureña
  • Andrew Kettle
  • Seza A. Gulec
  • Francesca Pons
  • Domenico RubelloEmail author


The present guidelines were issued by the Parathyroid Task Group of the European Association of Nuclear Medicine. The main focus was imaging of primary hyperparathyroidism. Dual-tracer and single-tracer parathyroid scintigraphy protocols were discussed as well as the various modalities of image acquisition. Primary hyperparathyroidism is an endocrine disorder with high prevalence, typically caused by a solitary parathyroid adenoma, less frequently (about 15%) by multiple parathyroid gland disease (MGD) and rarely (1%) by parathyroid carcinoma. Patients with MGD may have a double adenoma or hyperplasia of three or all four parathyroid glands. Conventional surgery has consisted in routine bilateral neck exploration. The current trend is toward minimally invasive surgery. In this new era, the success of targeted parathyroid surgery depends not only on an experienced surgeon, but also on a sensitive and accurate imaging technique. Recognizing MGD is the major challenge for pre-operative imaging, in order to not direct a patient towards inappropriate minimal surgery. Scintigraphy should also report on thyroid nodules that may cause confusion with a parathyroid adenoma or require concurrent surgical resection. The two main reasons for failed surgery are ectopic glands and undetected MGD. Imaging is mandatory before re-operation, and scintigraphy results should be confirmed with a second imaging technique (usually US for a neck focus, CT or MRI for a mediastinal focus). Hybrid SPECT/CT instruments should be most helpful in this setting. SPECT/CT has a major role for obtaining anatomical details on ectopic foci. However, its use as a routine procedure before target surgery is still investigational. Preliminary data suggest that SPECT/CT has lower sensitivity in the neck area compared to pinhole imaging. Additional radiation to the patient should also be considered. The guidelines also discuss aspects related to radio-guided surgery of hyperparathyroidism and imaging of chronic kidney disease patients with secondary hyperparathyroidism.


Hyperparathyroidism Primary hyperparathyroidism Secondary hyperparathyroidism Parathyroid surgery 99mTc-sestamibi Localization studies Scintigraphy Subtraction scanning Parathyroid adenoma Parathyroid hyperplasia Minimally invasive surgery Gamma probe 


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Copyright information

© EANM 2009

Authors and Affiliations

  • Elif Hindié
    • 1
  • Ömer Ugur
    • 2
  • David Fuster
    • 3
  • Michael ODoherty
    • 4
  • Gaia Grassetto
    • 5
  • Pablo Ureña
    • 6
  • Andrew Kettle
    • 7
  • Seza A. Gulec
    • 8
  • Francesca Pons
    • 3
  • Domenico Rubello
    • 5
    Email author
  1. 1.Service de Médecine NucléaireHôpital Saint-LouisParis Cedex 10France
  2. 2.Department of Nuclear MedicineFaculty of Medicine, Hacettepe UniversityAnkaraTurkey
  3. 3.Department of Nuclear MedicineHospital Clínic BarcelonaBarcelonaSpain
  4. 4.Department of Nuclear Medicine, PET CentreSt Thomas’ HospitalLondonUK
  5. 5.Department of Nuclear Medicine, PET Centre, Medical Physics and Radiology‘Santa Maria della Misericordia’ HospitalRovigoItaly
  6. 6.Service d’Explorations FonctionnellesHôpital NeckerParis Cedex 15France
  7. 7.Department of Nuclear MedicineKent and Canterbury HospitalCanterburyUK
  8. 8.Department of Surgical OncologyFlorida International University College of MedicineMiamiUSA

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