Preoperative Imaging of the Parathyroid Glands
Parathyroid diseases were a difficult and even incomprehensible theme for many years. Clinical manifestations of parathyroid abnormalities (osseous and visceral) were rare and presented a serious diagnostic and therapeutic problem. According to WHO, manif
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Preoperative Imaging of the Parathyroid Glands
Parathyroid diseases were a difficult and even incomprehensible theme for many years. Clinical manifestations of parathyroid abnormalities (osseous and visceral) were rare and presented a serious diagnostic and therapeutic problem. According to WHO, manifest forms of primary hyperparathyroidism (PHPT) in the middle of the 20th century prevailed in Western Europe and the United States. Wide variability of localization of parathyroid tumors created great difficulties for surgeons. In addition, asymptomatic PHPT forms (adenomas and carcinomas) were accidentally found during operations on the organs of the neck or superior mediastinum. Older methods permitted occasional identification of parathyroid tumors, but these methods had low specificity. This was the cause of many false-positive results, especially in the cases of combination with the pathology of the thyroid gland. It stimulated elaboration by more specific techniques, especially for diagnosing cases of atypical location of the parathyroid glands and of concomitant pathology of cervical and mediastinal organs. Interest in surgical aspects of PHPT has grown significantly during the past 20 years. There exist, however, different attitudes to the problem of diagnosis of hypercalcemia and osteoporosis. Quick and specific laboratory tests have opened new perspectives for the development of this new area in endocrinology and endocrine surgery. Hence, asymptomatic and normocalcemic forms of PHPT are diagnosed more often. Knowledge of the variants of the course of the disease has become more complete. The concept of the “para-
thyroid incidentaloma” appeared in medical practice. It owes its emergence in the first place to ultrasound (US), magnetic resonance imaging (MRI), and computed tomography (CT) imaging. The development of medical technologies and new methods of treatment of chronic renal failure (CRF) have also stimulated the study of parathyroid pathology. An opportunity to prolong the life of CRF patients using a program of hemodialysis lead to the increase in the incidence of secondary (SHPT) and tertiary hyperparathyroidism (THPT). A prolonged history of CRF leads to adenomatous parathyroid hyperplasia and parathyroid tumors in the majority of cases, which require surgical treatment. Modern surgical treatment of parathyroid pathology is based on accurate topical diagnosis of pathologic focus. That influences the choice of the method and technique of surgical intervention. Choosing the set of diagnostic procedures, surgeons are more often guided by the principle of “dual control.” This allows not only the precise detection of parathyroid lesions but also gives the opportunity to assess the results of the performed operation. All methods of topical diagnosis of abnormal parathyroid glands can be divided into three conditional groups: noninvasive preoperative, invasive preoperative, and intraoperative diagnostic methods, as follows: Noninvasive preoperative • Ultrasound • Thermography • Scanning with 131I or 99mT
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