New trends in parathyroid scintigraphy

The paper focusses on the recent advances in parathyroid imaging in both di agnostic and surgical fields which justify the present favourable trend tow ards a considerable expansion of nuclear medicine applications in this area . The main methodological advances in parathyroid scintigraphy are the rebi rth of the dual-tracer (subtraction) technique with technetium-99m sestamib i. the possibility of also using Tc-99m-tetrofosmin within a dual-tracer (s ubtraction) methodology and the more extensive use of single-photon emissio n tomography, which the authors believe will become the standard methodolog y. The indications for parathyroid scintigraphy have been affected by advan ces in hyperparathyroidism surgery, including wider use of unilateral neck exploration and of minimally invasive radioguided surgery. As these techniq ues can only be performed in hyperparathyroid patients with a single adenom a, careful pre-operative assessment is required, and parathyroid scintigrap hy undoubtedly is the most accurate localisation method. To date, the major ity of papers have also demonstrated the cost-effectiveness of scintigraphi cally guided limited neck surgery. The authors conclude that: (1) parathyro id scintigraphy can be recommended not only in persistent or recurrent hype rparathyroidism but also in hyperparathyroid patients prior to first surger y; (2) scintigraphy should always be performed by applying the most accurat e technique available because reliable scintigraphy gains or reinforces the surgeon's trust., reliably guides cost-effective operative strategies and justifies the recognition of new potential diagnostic indications.