DIAGNOSTIC LOCALIZATION STUDIES FOR PRIMARY HYPERPARATHYROIDISM

Objective: To assess the accuracy of preoperative imaging studies in p rimary hyperparathyroidism. Design: Retrospective review of all patien ts treated surgically for primary hyperparathyroidism at The Universit y of California-San Diego Medical Center between January 1990 and May 1999. Results of preoperative imaging studies were compared with surgi cal and pathologic findings. Setting: The University of California-San Diego Medical Center, a primary care and referral center. Participant s: Twenty-eight patients were included in the study, and a total of 41 imaging studies were obtained. Outcome Measures: The accuracy of preo perative imaging studies in correctly localizing the site of a parathy roid adenoma. Results: Ultrasound correctly identified the site of a s olitary parathyroid adenoma in 82% of cases, and magnetic resonance im aging in 80% of cases. The adenomas that were not localized by ultraso und were correctly localized by magnetic resonance imaging. These find ings are discussed within the context of recent trends in parathyroid surgery. Conclusions: Based on the results and a review of the literat ure, a simple algorithm for the use of these imaging studies is propos ed. Use of this algorithm will improve preoperative planning, and pote ntially reduce operative time and morbidity.