Ks. Heller et al., PARATHYROID LOCALIZATION - INABILITY TO PREDICT MULTIPLE GLAND INVOLVEMENT, The American journal of surgery, 166(4), 1993, pp. 357-359
Preoperative localization using various imaging techniques can accurat
ely predict the location of solitary parathyroid adenomas in about 75%
of patients. Its value has been questioned because of the high succes
s rate of parathyroid exploration without localization. The ability of
localization studies to differentiate preoperatively between patients
with solitary adenomas and those with multiple gland disease would be
valuable because bilateral exploration might be avoided in many cases
. Ultrasonography, thallium-201/technetium-99m subtraction scintigraph
y, and magnetic resonance imaging were used to evaluate 16 patients wi
th primary hyperparathyroidism who were ultimately found at surgery to
have multiple enlarged parathyroid glands. No single imaging techniqu
e was able to identify more than 53% of enlarged glands, and only four
patients were accurately predicted preoperatively to have enlargement
of multiple parathyroid glands. Existing imaging techniques cannot be
relied on to predict multiple gland involvement preoperatively. Bilat
eral surgical exploration is mandatory in all patients with primary hy
perparathyroidism.