E5188. Avoid the Moans, Groans, Stones, and Psychiatric Overtones: Pearls and Pitfalls from Parathyroid Tumor Board Cases
Authors
Dan Gray;
University of New Mexico
Nathan Drasler;
University of New Mexico
Kathryn Welch;
University of New Mexico
Mark Ehrhart;
University of New Mexico
Shana Elman;
University of New Mexico
Background
At our institution, we have a multidisciplinary Parathyroid Tumor Board that reviews multimodality imaging for all cases scheduled for parathyroidectomy. Images are reviewed both pre- and postoperatively, providing essential feedback to enhance the subspecialty expertise of our radiologists (nuclear medicine and neuroradiology), endocrinologists, and ENT surgeons. Through illustrative cases, we hope to share some of the pearls and pitfalls that we have learned along the way, enhancing the reader's expertise in multimodality parathyroid imaging.
Educational Goals / Teaching Points
Understand common locations for superior, interior, and ectopic parathyroid glands/adenomas. Learn common findings of parathyroid adenoma on 99mTc-Sestamibi scintigraphy, thyroid ultrasound, and 4D CT. Learn how correlative imaging can increase confidence in the diagnosis of a parathyroid adenoma, particularly when the imaging appearance is somewhat atypical.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Illustrative cases from the Parathyroid Tumor Board will be shown to demonstrate common and uncommon findings of parathyroid adenomas on 99mTc-Sestamibi scintigraphy, thyroid ultrasound, and 4D CT. The added benefit from multimodality correlation will be highlighted, with particular discussion and case selection to provide deeper understanding of potential pitfalls in image interpretation and problem-solving strategies for challenging cases. When relevant, changes in management resulting from the imaging findings will be discussed, such as altered operative approach.
Conclusion
Parathyroid imaging is often obtained for preoperative planning in patients with hyperparathyroidism. Optimal interpretation of these studies requires a nuanced understanding of both typical and atypical appearances, as well as an appreciation for the added benefit that correlative multimodality imaging can provide. After reviewing this exhibit, the reader will gain confidence in interpreting parathyroid imaging, as well as problem-solving strategies to utilize when challenging cases are encountered.
