Diagnostic Imaging Pathways - Suspected Primary Hyperparathyroidism

Computed Tomography and Magnetic Resonance Imaging

• CT and MRI of the neck and mediastinum are generally considered second line investigations in the assessment of primary hyperparathyroidism, following on from equivocal or negative ultrasound or nuclear medicine studies. 24
• Their main advantage is superior spatial resolution and the detailed anatomical localisation of ectopic mediastinal lesions for surgical planning. 24
• The sensitivity of CT for preoperative localisation of abnormal parathyroid tissue ranges from 78% to 86%. 25-27
• MRI demonstrates similar sensitivity ranging from 71% to 92%. 28-30
• These modalities are particularly useful for persistent or recurrent hyperparathyroidism when more detailed surgical planning is required to minimise the risks associated with repeat surgery and to improve the chances of succesful treatment. 31
• The disadvantages of these studies include:
  1. Exposure to ionising radiation with CT
  2. The use of intravenous contrast

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