New trends in parathyroid scintigraphy.

The paper focusses on the recent advances in parathyroid imaging in both diagnostic and surgical fields which justify the present favourable trend towards a considerable expansion of nuclear medicine applications in this area. The main methodological advances in parathyroid scintigraphy are the rebirth of the dual-tracer (subtraction) technique with technetium-99m sestamibi, the possibility of also using 99mTc-tetrofosmin within a dual-tracer (subtraction) methodology and the more extensive use of single-photon emission tomography, which the authors believe will become the standard methodology. The indications for parathyroid scintigraphy have been affected by advances in hyperparathyroidism surgery, including wider use of unilateral neck exploration and of minimally invasive radioguided surgery. As these techniques can only be performed in hyperparathyroid patients with a single adenoma, careful pre-operative assessment is required, and parathyroid scintigraphy undoubtedly is the most accurate localisation method. To date, the majority of papers have also demonstrated the cost-effectiveness of scintigraphically guided limited neck surgery. The authors conclude that: (1) parathyroid scintigraphy can be recommended not only in persistent or recurrent hyperparathyroidism but also in hyperparathyroid patients prior to first surgery; (2) scintigraphy should always be performed by applying the most accurate technique available because reliable scintigraphy gains or reinforces the surgeon's trust, reliably guides cost-effective operative strategies and justifies the recognition of new potential diagnostic indications.