Diagnostic Localization Studies for Primary Hyperparathyroidism: A Suggested Algorithm

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Abstract
To assess the accuracy of preoperative imaging studies in primary hyperparathyroidism. Retrospective review of all patients treated surgically for primary hyperparathyroidism at The University of California-San Diego Medical Center between January 1990 and May 1992. Results of preoperative imaging studies were compared with surgical and pathologic findings. The University of California-San Diego Medical Center, a primary care and referral center. Twenty-eight patients were included in the study, and a total of 41 imaging studies were obtained. The accuracy of preoperative imaging studies in correctly localizing the site of a parathyroid adenoma. Ultrasound correctly identified the site of a solitary parathyroid adenoma in 82% of cases, and magnetic resonance imaging in 80% of cases. The adenomas that were not localized by ultrasound were correctly localized by magnetic resonance imaging. These findings are discussed within the context of recent trends in parathyroid surgery. Based on the results and a review of the literature, a simple algorithm for the use of these imaging studies is proposed. Use of this algorithm will improve preoperative planning, and potentially reduce operative time and morbidity.