Diagnostic Imaging Pathways - Suspected Primary Hyperparathyroidism

Selective Venous Sampling

• Selective venous sampling is an invasive procedure which is generally only considered in the preoperative localisation of abormal parathyroid tissue for recurrent or persistent hyperparathyroidism when non-invasive imaging methods have failed. 33
• It involves selective cannulation of cervical and mediastinal veins to sample venous PTH levels. Local elevations of serum PTH compared to peripheral levels allow target areas to be defined for surgery (at least a two-fold gradient is required). Therefore, the effectiveness of this procedure depends upon production of PTH by the parathyroid glands and not on their size. 33
• In the setting of recurrent or persistent hyperparathyroidism, the sensitivity for the localisation of abnormal parathyroid tissue ranges from 80 to 94% and the specificity from 85 to 100%. 33-34
• The disadvantages of selective venous sampling include its
  1. Invasiveness with risks of haemorrhage and infection
  2. Exposure to ionising radiation and intravenous contrast

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