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Vol. 38. Issue 2.
Pages 123-135 (March - April 2019)
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Vol. 38. Issue 2.
Pages 123-135 (March - April 2019)
Continuing Education
Update of the role of Nuclear Medicine techniques in the pre-surgical localization of primary hyperparathyroidism
Actualización sobre el papel de las técnicas de Medicina Nuclear en el diagnóstico de localización prequirúrgico en el hiperparatiroidismo primario
P. García-Talavera San Miguel
Corresponding author

Corresponding author.
, F. Gómez-Caminero López, J.G. Villanueva Curto, M.P. Tamayo Alonso, M.E. Martín Gómez
Servicio de Medicina Nuclear, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
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Tables (5)
Table 1. Protocol of planar scintigraphy and SPECT (taken from the SNM42).
Table 2. Scintigraphy results: planar (subtraction/DP) vs. SPECT (parallel/pinhole).
Table 3. Scintigraphy results: planar vs. SPECT vs. SPECT/CT.
Table 4. Protocol of SPECT/CT (taken from Greenspan et al.42).
Table 5. Scintigraphic technique (planar/SPECT) vs. moprhological technique (US/CT/MR) vs. combined techniques.
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Primary hyperparathyroidism is one of the most frequent endocrine disorders. Its diagnosis is biochemical. Imaging techniques are not useful for the diagnosis of this pathology; they are just tools for pre-surgical localization. In this continuing education, we will analyze the different imaging modalities used in this indication, focusing on Nuclear Medicine. The most commonly used imaging technique in this context is the parathyroid scintigraphy, nowadays double phase protocol with 99mTc-MIBI and the double tracer with 99mTc-MIBI/99mTc-pertechnetate, associated in the first case to SPECT or SPECT/CT, in an early or late phase. The PET/CT with different tracers is showing good results, especially applied to cases of failure in the pre-surgical scintigraphic localization. We expose the results of the morphological imaging techniques as well, and the usefulness of combining techniques.

Primary hiperparathyrodism
Pre-surgical localization

El hiperparatiroidismo primario es una de las enfermedades endocrinas más frecuentes. Su diagnóstico es bioquímico. Las pruebas de imagen no tienen utilidad para el diagnóstico de esta afección, únicamente son pruebas localizadoras prequirúrgicas. En esta formación continuada analizaremos las diferentes modalidades de imagen empleadas en esta indicación, centrándonos en la Medicina Nuclear. La técnica de imagen más empleada en este contexto es la gammagrafía de paratiroides, en la actualidad la técnica de doble fase con 99mTc-MIBI y la de doble trazador 99mTc-MIBI/99mTc-pertecnetato, asociada en el primer caso a una SPECT o SPECT/TC, en tiempo precoz o tardío. La PET/TC con diferentes trazadores está demostrando buenos resultados, aplicada fundamentalmente en los casos de fallo de localización prequirúrgica de la gammagrafía. Exponemos, asimismo, los resultados de las técnicas de imagen morfológicas, y la utilidad de la combinación de técnicas.

Palabras clave:
Hiperparatiroidismo primario
Localización prequirúrgica


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