1. The New York Center for Advanced Parathyroid Surgery
15 Maple Avenue | Warwick, NY 10990
Toll Free: 888-760-0966
Parathyroid Imaging Techniques
The major function of the parathyroid glands is to maintain
the body's calcium level in both the blood and bones. These
glands are responsible for producing the parathyroid
hormone (PTH) which exists to help regulate calcium levels in
the bloodstream.
Primary hyperparthyroidism is most commonly caused by one
or more of the parathyroid glands forming a tumor that
secretes excessive parathyroid hormone.
Preoperative parathyroid imaging and localization provides an important role in providing preoperative
evaluation of patients with primary hyperparathyroidism. Finding the tumor before incision allows a
surgeon to make a smaller incision without the need to do a traditional neck exploration.
Imaging studies are performed only after a diagnosis of primary hyperparathyroidism is established
through biochemical findings.
Common Parathyroid Imaging Scans
The parathyroid sestamibi scan is the preferred test to find an abnormal
parathyroid gland. Sestamibi is a small protein that is labeled with the
radiopharmaceutical technetium-99m. Tc99m Sestamibi is a very safe and
mild radioactive agent that is injected and then preferably absorbed by the
abnormal parathyroid gland i.e. parathyroid adenoma. Using an advanced
gamma nuclear camera, the abnormal gland can then be visualized and
localized in the neck. Normal parathyroid glands typically will not take up the
radioactive particles because they are suppressed by an elevated calcium level caused by the abnormal
gland .Therefore, a Sestamibi scan of the parathyroid gland will show the one bad parathyroid tumor
and it will NOT show normal glands. The other 3 parathyroids are essentially sleeping and not
functioning at a normal state. The normal parathyroids produce relatively minimal parathyroid
hormone.
The sestamibi scan procedure usually takes less than three hours. Unlike other iodine-based procedures,
the Tc-99 sestamibi scan does not produce any allergies or adverse reactions.
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2. The New York Center for Advanced Parathyroid Surgery
15 Maple Avenue | Warwick, NY 10990
Toll Free: 888-760-0966
The sestamibi scan can be an extremely accurate and sensitive test; when performed correctly it
localizes approximately 70% of parathyroid adenomas. If this test is done at a hospital with less
experience, the percent of positive scans decreases. If this nuclear scan is positive, there is a greater
than 95% specificity i.e. it is very likely that the active area of the parathyroid scan represents the
parathyroid adenoma.
Parathyroid ultrasound is a relatively inexpensive and
non-invasive test that does not require radiation.
Additionally, ultrasound of the thyroid and
parathyroid glands is used preoperatively to rule out
thyroid nodules that may need to be evaluated prior
to parathyroid surgery. It is not particularly accurate
in localizing a parathyroid adenoma.
A high-resolution parathyroid CT scan is used to help localize a
parathyroid tumor when a parathyroid scan and parathyroid
ultrasound were unsuccessful at localizing the tumor. A CT scan is
quicker and less expensive than an MRI. Since the introduction of
Sestamibi scans, CT scans are not performed as frequently today.
Parathyroid MRI is reserved for cases of primary
hyperparathyroidism where properly performed Sestamibi scan
and high-resolution parathyroid ultrasound did not localize a
parathyroid adenoma.
SPECT (Single Photon Emission Computerized Tomography) scanning is a 3-D method of Parathyroid
Sestamibi Scan. With this method 3-dimensional images of the parathyroid can be taken after
Technetium-99m Sestamibi is injected. This method is 2-3 percent more accurate than a standard
parathyroid scan.
Identifying the specific overactive parathyroid gland before the operation is the preferred method of
performing parathyroid surgery. Advanced noninvasive parathyroid imaging techniques help determine
exactly where to operate, resulting in less scarring and faster patient recovery.
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3. The New York Center for Advanced Parathyroid Surgery
15 Maple Avenue | Warwick, NY 10990
Toll Free: 888-760-0966
Minimally Invasive Parathyroidectomy
At the New York Center for Advanced Parathyroid Surgery, we have the benefit of placing our operative
suites next to our imaging facility enabling the ready use of the minimally invasive parathyroidectomy
technique.
About 97% of parathyroid disease patients have only one bad parathyroid. So rather than use the
traditional parathyroid operation technique requiring a large neck incision to locate and examine the
four parathyroid glands, the minimally invasive surgical technique simply remove the one bad gland and
leave the others alone.
Minimally invasive parathyroid surgery is an outpatient procedure that requires just a one-inch incision
and can be performed in less than half an hour. In addition, patients recover faster with minimal
scarring.
At the New York Center for Advanced Parathyroid Surgery, we perform the latest in minimally invasive
parathyroid surgical techniques. For more information about your parathyroid surgery treatment
options, visit www.advancedparathyroid.com.
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