This book provides a visual demonstration of normal and ectopic locations of parathyroid adenomas using different modalities in patients with PHPT and to describe parathyroid gland–related pathology. It includes several modern imaging modalities for localization of parathyroid glands and parathyroid adenomas, such as Sestamibi scan, SPECT/CT Sestamibi scan, neck ultrasound, MRI, thin-cut CT, and 4D CT scans. Written by experts in the field, chapters include pathology images corresponding to radiology imaging for some presented cases (gross and high-power view). Authors have also collected radiological images of difficult-to-localize parathyroid adenomas in ectopic (abnormal) locations. The atlas is organized by location of the adenomas in upper and lower eutopic locations followed by ectopic locations. Each case demonstrates dual or triple modalities such as US, Sestamibi scan, or SPECT/CT Sestamibi scan, thin-cut CT scan, or 4D CT performed on the same patient. A chapter on parathyroid pathology is also included to help the reader understand challenges in pathological interpretation.
Atlas of Parathyroid Imaging and Pathology serves as a valuable reference for radiologists, endocrine surgeons, head and neck surgeons, ENT surgeons, surgical oncologists, endocrinologists, pathologists, nephrologists, students, and all physicians and allayed health practitioners involved in the treatment of patients with primary, secondary, and tertiary hyperparathyroidism.
Author(s): Alexander L. Shifrin, L. Daniel Neistadt, Pritinder K. Thind
Publisher: Springer
Year: 2020
Language: English
Pages: 283
City: Cham
Preface
Acknowledgments
Contents
Contributors
Part I: Ultrasound, Sestamibi Scan, and Pathology of the Parathyroid Glands
1: Parathyroid Ultrasound
Introduction: Diagnosis of Hyperparathyroidism
Principles of Ultrasound
Parathyroid Ultrasound in Operative Planning
Performing the Ultrasonography
Evaluating a Parathyroid Adenoma
References
2: Scintigraphic Parathyroid Imaging
Parathyroid Embryology
Hyperparathyroidism Classification
Scintigraphic Imaging
Selenomethionine 75
Technetium 99m–Thallium-201 Subtraction
Technetium-99m Sestamibi
Technetium-99m Sestamibi and I-123 Subtraction Imaging
Technetium-99m Pertechnetate – Technetium-99m Sestamibi
Dual-Phase Technetium-99m Sestamibi Imaging with SPECT/SPECT-CT
18F-Choline PET/CT
C-11 Methionine PET and PET-CT
False-Positive Scintigraphic Findings
False-Negative Scintigraphic Findings
Comparison of Various Scintigraphic Parathyroid Imaging Techniques
References
3: Pathology of the Parathyroid Glands
Anatomy and Histology
Hyperparathyroidism
Parathyroid Adenoma
Clinical Findings
Gross Findings
Microscopic Findings
Atypical Parathyroid Adenoma
Parathyroid Hyperplasia
Clinical Findings
Gross Findings
Microscopic Findings
Secondary Hyperparathyroidism
Tertiary Hyperparathyroidism
Parathyroid Carcinoma
Clinical Findings
Gross Findings
Microscopic Findings
Prognosis
Familial Hyperparathyroidism
Intraoperative Assessment of Parathyroid Lesions
Secondary Tumors
Miscellaneous Parathyroid Lesions
Parathyroid Cyst
Parathyromatosis
Hypoparathyroidism
References
Part II: Normal Anatomical Location of the Parathyroid Gland Adenomas: Ultrasound, Sestamibi Scan, and Gross Pathology
4: Right Superior Parathyroid Adenoma
Suggested Reading
5: Right Inferior Parathyroid Adenoma
Suggested Reading
6: Left Superior Parathyroid Adenoma
Suggested Reading
7: Left Inferior Parathyroid Adenoma
Suggested Reading
Part III: Intrathyroidal Parathyroid Adenoma, Cystic Parathyroid Adenoma, and Parathyroid Carcinoma
8: Ultrasonography, Sestamibi Scan, and SPECT/CT Sestamibi Scan of Intrathyroidal Parathyroid Adenoma and Cystic Parathyroid Adenoma
Suggested Reading
9: Imaging of the Parathyroid Carcinoma
Suggested Reading
Part IV: CT Scan of the Neck in Evaluation of Parathyroid Glands
10: Motivation for Imaging Studies
Single-Gland Disease
Multigland Disease
Ectopic Glands
Diagnostic Terminology
Sestamibi Scan
Mechanism of Radionuclide Uptake
Imaging
Dealing with Thyroid Activity
Ectopic Parathyroid Activity
Value of the Sestamibi Study
Ultrasound
CT Scan
References
11: Contrast CT Approach
Basis for the CT Approach
Accuracy of the CT-Based Screening Approach
Value of the CT Study
Non-contrast CT
References
12: The CT Technique
General Description
Identification of Normal-Size Parathyroid Glands
Details of the Dynamic Process of Perfusion
Performing the CT Scan
Number of Detectors and Reconstructions
Direction of the Scan
Technical Tweaks
References
13: Individual CT Phases
Precontrast Phase
Arterial Phase
Timing of Arterial Phase
Identifying the Parathyroid Gland on Arterial Phase
Streak Artefact Obscuring the Enhancing Parathyroid
Venous Phase
Timing of Venous Phase
Parathyroid Gland Behavior in Venous Phase
Variations in Quality of the Venous Phase
Value of Venous Phase in Identifying a Parathyroid Nodule
References
14: Sources of False Positive and False Negative Enlarged Parathyroid Glands
Thyroid Tissue and Thyroid Nodules as Source of False Positive
Ectopic Thyroid Tissue as False Positive
Hashimoto’s Thyroiditis as Source of False Positives and False Negatives
False Negative Due to Subcapsular Location in Normal Thyroid Parenchyma
False Positives or False Negatives Due to Lymph Nodes
Multinodular Goiter as Source of False Negative
Ectopic Parathyroid Glands as False Negatives
References
15: Correlative Ultrasound
Ultrasound Characteristics of Parathyroid Glands
CT Guidance for the Ultrasound Search
Ultrasound Technique
References
16: Shape, Number, and Size of Parathyroids
Shape of Parathyroid Glands
Parathyroid Gland Number
Size of the Parathyroid Gland
References
17: Location of Parathyroid Glands
Superior or Upper Parathyroid Glands
Inferior or Lower Parathyroid Glands
Value of Describing the Location of Normal-Size Glands
Ectopic Locations
Intrathyroidal Parathyroid Glands
Undescended Parathyroid Glands
Mediastinal Parathyroid Glands
Unusual Ectopic Locations
Communicating the Location Findings
“Perrier” Classification Scheme to Locate Parathyroid Glands
Location of Parathyroid Relative to Recurrent Laryngeal Nerve
References
18: Multigland Disease
Primary Hyperplasia
Scoring System for Assessing the Likelihood of Multigland Disease
Secondary Parathyroid Hyperplasia
References
19: Rare Parathyroid Presentations
Cystic Parathyroid Lesions
Parathyroid Carcinoma
Lipoadenoma
Parathyromatosis
Water–Clear Cell Hyperplasia and Adenoma
References
20: Illustrative Cases
Superior Glands
Case 1: Normal Superior Glands
Case 2: Typical Superior Parathyroid Adenoma in Usual Position with Typical Enhancement Pattern
Case 3: Enlarged Superior Parathyroid Gland in Slightly Higher Position in Broad Contact with Left Lobe
Case 4: Enlarged Superior Parathyroid Glands, Subcapsular
Case 5: Superior Parathyroid Adenoma with Unusual Echogenic Character on Ultrasound
Case 6: Double Adenoma (Right Superior and Left Inferior in Indeterminate Position)
Case 7: Type D Parathyroid Adenoma
Case 8: Low-Lying Bilateral Superior Parathyroid Adenomas
Case 9: High Superior Parathyroid Adenoma, Slightly Ectopic Location
Case 10: High Retropharyngeal Parathyroid Adenoma Just Above the Upper Pole
Case 11: Retropharyngeal Parathyroid Adenoma with Thick Vascular Pedicle
Superior Adenomas Attached to the Esophagus
Case 12: Bilateral Adenomas with One Attached to the Esophagus
Case 13: Enlarged Parathyroid Attached to the Esophagus
Inferior Parathyroids
Case 14: Normal-Size Inferior Parathyroid Gland
Case 15: Small Inferior Adenoma
Case 16: Inferior Adenoma
Case 17: Inferior Adenoma Best Seen on Ultrasound
Case 18: Inferior Adenoma in Thyrothymic Ligament
Case 19: Inferior Adenoma in an Early Arterial Phase
Case 20: Inferior Adenoma, Partially Intrathymic
Intrathyroidal Adenoma
Case 21: Intrathyroidal Adenoma (Post Fine-Needle Aspiration)
Case 22: Intrathyroidal Adenoma with Past Central Hemorrhage
Primary Parathyroid Hyperplasias
Case 23: Asymmetric Primary Hyperplasia
Case 24: Hyperplasia Presenting with Sequential Activity of Enlarged Parathyroid Glands
Case 25: Primary Hyperplasia
Case 26: Primary Hyperplasia with Dominant Enlarged Gland on CT
Case 27: Hyperplasia with Mostly Normal-Size Parathyroid Glands
Case 28: Primary Hyperplasia with Intrathyroidal Parathyroid
Ectopic Parathyroids: Undescended Parathyroid Adenomas
Case 29: Undescended Parathyroid Adenoma
Case 30: Undescended Enlarged Parathyroid Gland
Case 31: Undescended Parathyroid Adenoma at C2-C3 Levels
Case 32: Undescended Enlarged Parathyroid Gland
Ectopic Parathyroids: Mediastinal Parathyroids
Case 33: Mediastinal Parathyroid Adenoma in Anterior Mediastinum (in Thymus)
Case 34: Mediastinal Fifth Parathyroid Gland in a Primary Hyperplasia
Case 35: Enlarged Mediastinal Parathyroid Gland in Aortopulmonary Window
Case 36: Mediastinal Parathyroid Adenoma in Middle Mediastinum
Postsurgical Cases
Case 37: Recurrent Adenoma at Site of Previous Parathyroidectomy
Case 38: Recurrent Hyperparathyroidism with Scar at Site of Left Lower Parathyroidectomy
Case 39: Parathyroid Adenoma in Post-thyroidectomy Bed
Case 40: Renal Secondary Hyperparathyroidism
Case 41: Renal Secondary Hyperparathyroidism with Mediastinal Parathyroid glands
Interesting and Rare Cases
Case 42: Parathyroid Hyperplasia with a Background of Hashimoto’s Thyroiditis
Case 43: Cystic Parathyroid Adenoma
Case 44: Large Multicystic-Appearing Parathyroid Adenoma Due to Hemorrhage
Case 45: Cystic Parathyroid Adenoma with Hemorrhage
Case 46: Water–Clear Cell Bilateral Adenomas
References
21: Summary: CT Scan of the Neck in the Evaluation of Parathyroid Glands
Recommended Reading
Part V: Invasive Techniques for Parathyroid Localization
22: Invasive Techniques for Parathyroid Localization
Introduction
Hypocalcemic Stimulation of Parathyroid Hormone Production
Case Study: Mediastinal Parathyroid
Case Study: Occult Enlarged Parathyroid Gland in the Neck Requiring Functional Studies for Localization
Parathyroid Contrast Ablation: Case Study
References
Part VI: MRI of the Parathyroid Glands
23: MRI for Imaging Parathyroid Disease
MRI Protocol
Conventional MRI Sequences
Field of View
T1 and T2 MRI Sequences for Parathyroid Evaluation
Fat Saturation/Suppression
Time-Resolved MRI
Dynamic Image Interpretation and Post-processing Techniques
MRI for Evaluation of Hyperparathyroidism in the Post-surgical Neck
Conclusion/Summary
References
Index
