American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism

Head Neck. 2019 Jul;41(7):2398-2409. doi: 10.1002/hed.25781. Epub 2019 Apr 19.


Health care consumer organizations and insurance companies increasingly are scrutinizing value when considering reimbursement policies for medical interventions. Recently, members of several American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) committees worked closely with one insurance company to refine reimbursement policies for preoperative localization imaging in patients undergoing surgery for primary hyperparathyroidism. This endeavor led to an AAO-HNS parathyroid imaging consensus statement ( The American Head and Neck Society Endocrine Surgery Section gathered an expert panel of authors to delineate imaging options for preoperative evaluation of surgical candidates with primary hyperparathyroidism. We review herein the current literature for preoperative parathyroid localization imaging, with discussion of efficacy, cost, and overall value. We recommend that planar sestamibi imaging, single photon emission computed tomography (SPECT), SPECT/CT, CT neck/mediastinum with contrast, MRI, and four dimensional CT (4D-CT) may be used in conjunction with high-resolution neck ultrasound to preoperatively localize pathologic parathyroid glands. PubMed literature on parathyroid imaging was reviewed through February 1, 2019.

Keywords: parathyroid imaging; parathyroid imaging modalities; review; value in health care.

Publication types

  • Consensus Development Conference
  • Review

MeSH terms

  • Four-Dimensional Computed Tomography
  • Humans
  • Hyperparathyroidism, Primary / surgery*
  • Magnetic Resonance Imaging
  • Minimally Invasive Surgical Procedures
  • Multidetector Computed Tomography
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Hormone / blood
  • Parathyroidectomy / methods
  • Preoperative Care
  • Radiopharmaceuticals
  • Sensitivity and Specificity
  • Single Photon Emission Computed Tomography Computed Tomography
  • Societies, Medical
  • Technetium Tc 99m Sestamibi
  • Ultrasonography


  • Parathyroid Hormone
  • Radiopharmaceuticals
  • Technetium Tc 99m Sestamibi