The EANM practice guidelines for parathyroid imaging

Eur J Nucl Med Mol Imaging. 2021 Aug;48(9):2801-2822. doi: 10.1007/s00259-021-05334-y. Epub 2021 Apr 10.


Introduction: Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration.

Methods: Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT.

Conclusion: These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.

Keywords: 18F-labeled choline analogues; 4D-CT; Cervical ultrasonography; Dual-phase scintigraphy; Dual-tracer scintigraphy; Hyperparathyroidism; MRI; PET/CT; Parathyroid scintigraphy; SPECT/CT; [11C]CH; [11C]MET; [99mTc]Tc-MIBI; [99mTc]Tc-tetrofosmin.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Humans
  • Hyperparathyroidism, Primary* / diagnostic imaging
  • Nuclear Medicine*
  • Parathyroid Glands / diagnostic imaging
  • Parathyroid Glands / surgery
  • Positron Emission Tomography Computed Tomography
  • Radionuclide Imaging
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi


  • Technetium Tc 99m Sestamibi