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Parathyroid Imaging

Parathyroid Imaging

Based on comprehensive evidence in the medical literature and expert opinion, the American Academy of Otolaryngology – Head and Neck Surgery affirms that select preoperative imaging can facilitate localization of hyperfunctional parathyroid glands and thus improve outcomes for patients undergoing surgery for hyperparathyroidism. Examples of imaging modalities that consistently provide the most accurate and detailed preoperative anatomic localization of hyperfunctional parathyroid glands include but are not limited to: high resolution neck ultrasound; CT neck/mediastinum with contrast; Sestamibi Tc99m radionuclide with SPECT/CT fusion; and MRI.

Revised 12/2017
Adopted 03/11/2018


  1. Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, Dackiw AP, Tufano RP, Zeiger MA, Ziessman HA. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med. 2007 Jul;48(7):1084-9.
  2. Oksüz MO, Dittmann H, Wicke C, Müssig K, Bares R, Pfannenberg C, Eschmann SM. Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT-CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol. 2011 Dec;17(4):297-307.
  3. Neumann DR, Obuchowski NA, Difilippo FP. Preoperative 123I/99mTc-sestamibi subtraction SPECT and SPECT/CT in primary hyperparathyroidism. J Nucl Med. 2008 Dec;49(12):2012-7.
  4. Smith RB, Evasovich M, Girod DA, et al. Ultrasound for localization in primary hyperparathyroidism. Otolaryngol Head Neck Surg. 2013 Sep;149(3):366-71.
  5. Kluijfhout WP, Venkatesh S, Beninato T, et al. Performance of magnetic resonance imaging in the evaluation of first-time and reoperative primary hyperparathyroidism. Surgery. 2016 Sep;160(3):747-54.

Important Disclaimer Notice (Updated 7/31/14)

Position Statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official Position Statements and are added to the existing Position Statement library. In no sense do they represent a standard of care. The applicability of Position Statements, as guidance for a procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical Position Statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this Position Statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results. Position Statements are not intended to and should not be treated as legal, medical, or business advice.

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