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Imaging and intervention of parathyroid hyperplasia 

Imaging and intervention of parathyroid hyperplasia
Chapter:
Imaging and intervention of parathyroid hyperplasia
Author(s):

Hirotaka Komaba

, Motoko Tanaka

, and Masafumi Fukagawa

DOI:
10.1093/med/9780199559176.003.030
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date: 05 July 2020

Evaluation of parathyroid hyperplasia by various imaging methods provides useful information in CKD patients. Routine examination of parathyroid by high resolution ultrasonography is recommended in CKD patients with increased PTH levels. Evaluation of parathyroid size and blood supply by power Doppler ultrasonography is highly useful for the differentiation between diffuse and nodular hyperplasia. With such advances in ultrasound imaging, interventional therapies such as PEIT became a practical therapeutic modality to control severe HPT, especially in patients with one enlarged gland. For preoperative localization, scintigraphy in combination with either MRI or CT adds more information especially on ectopic glands, although routine use of these modalities at initial surgery still remains controversial. When these modalities are inconclusive or negative despite the presence of severe HPT, other procedures such as selective venous sampling and positron emission tomography with 11C-methionin may be indicated. Further progress of parathyroid imaging techniques would provide more accurate localization and quantitative evaluation of parathyroid hyperplasia and would open new approaches to rational treatment strategies for 2HPT.

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