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Parathyroid Imaging in Patients with Renal Hyperparathyroidism

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Parathyroid Glands in Chronic Kidney Disease

Abstract

Secondary hyperparathyroidism (sHPT) is a complication of end-stage renal disease and long-term dialysis. When sHPT is resistant to optimal medical treatment, parathyroidectomy may be required. The role of imaging in sHPT is to visualize parathyroid glands and plan the best surgical strategy. Imaging should help detect ectopic and supranumerary glands. It should also help select a parathyroid gland with lesser degree of overfunction to be used as remnant or transplant, thus reducing the risk of recurrence. Currently, parathyroid ultrasound and 99mTc-Sestamibi parathyroid scintigraphy represent the first-line imaging strategy. Ultrasound imaging is a non-irradiating and low cost modality. However, ectopic parathyroid glands are often missed by ultrasound. Detection of ectopy as well as information on function based on intensity of tracer uptake are major advantages of scintigraphy. Conventional scintigraphy is best performed using the dual-tracer 99mTc-Sestamibi plus iodine-123 technique with image subtraction. Also, complementing planar images, with a SPECT/CT acquisition on modern hybrid cameras, offers useful anatomic information. Patients who need reoperation because of persistent/recurrent parathyroid disease often require a combination of imaging modalities. Four-phase CT or magnetic resonance imaging can be helpful in case of ectopic glands. Recently, 18F-fluorocholine PET/CT has proved useful as second line imaging in complex situations and in persistent/recurrent disease.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Haut-Lévêque Hospital, CNRS-UMR 5287, Translational and Advanced Imaging Laboratory (TRAIL), University of Bordeaux, Bordeaux, France

    Elif Hindié

  2. AURA Nord Saint Ouen, Department of Dialysis and Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France

    Pablo A. Ureña-Torres

  3. Department of Nuclear Medicine, La Timone Hospital, CERIMED, Aix-Marseille University, Marseille, France

    David Taïeb

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  1. Elif Hindié
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  2. Pablo A. Ureña-Torres
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  3. David Taïeb
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Correspondence to Elif Hindié .

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Editors and Affiliations

  1. Internal Medicine - Nephrology, Grigore T. Popa University of Medicine and Pharmacy, Iași, Romania

    Adrian Covic

  2. Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, London, UK

    David Goldsmith

  3. Nephrology-Dialysis Service, AURA Nord Saint Ouen, Saint Ouen, France

    Pablo A. Ureña Torres

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Hindié, E., Ureña-Torres, P.A., Taïeb, D. (2020). Parathyroid Imaging in Patients with Renal Hyperparathyroidism. In: Covic, A., Goldsmith, D., Ureña Torres, P. (eds) Parathyroid Glands in Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-43769-5_3

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