Parathyroid Imaging

Radiol Clin North Am. 2020 Nov;58(6):1071-1083. doi: 10.1016/j.rcl.2020.07.006. Epub 2020 Sep 17.


Primary hyperparathyroidism (PHPT) is a common endocrine abnormality, caused in most cases by a single parathyroid adenoma. Surgery remains the first-line curative therapy in PHPT. Imaging plays a vital role in presurgical localization of parathyroid adenomas. Ultrasound provides a safe and quick imaging modality free of ionizing radiation, but is operator dependent. Sestamibi scan offers comparable sensitivity to ultrasound, improved with concurrent tomographic imaging. 4DCT remains a problem-solving technique in challenging cases and after failed neck exploration. We present an overview of various parathyroid imaging modalities, including protocols and findings, in addition to relevant pearls and pitfalls.

Keywords: Four-dimensional CT; Hyperparathyroidism; Imaging; Parathyroid; Radiology; Sestamibi; Ultrasound.

Publication types

  • Review

MeSH terms

  • Diagnostic Imaging / methods
  • Female
  • Humans
  • Hyperparathyroidism, Primary / diagnostic imaging*
  • Hyperparathyroidism, Primary / etiology
  • Imaging, Three-Dimensional*
  • Male
  • Parathyroid Glands / diagnostic imaging
  • Parathyroid Glands / pathology
  • Parathyroid Glands / surgery
  • Parathyroid Neoplasms / complications*
  • Parathyroid Neoplasms / diagnostic imaging*
  • Parathyroid Neoplasms / pathology
  • Parathyroid Neoplasms / surgery
  • Parathyroidectomy / methods
  • Prognosis
  • Radiographic Image Enhancement*
  • Radiopharmaceuticals
  • Tomography, X-Ray Computed / methods*
  • Treatment Outcome
  • Ultrasonography, Doppler / methods


  • Radiopharmaceuticals