Combined SPECT/CT and ultrasound imaging in preoperative localization of parathyroid adenomas and its advantages in identification of pedunculated upper pole adenomas

Learning Objectives 1. Illustrate the use of hybrid SPECT/CT fusion imaging in localization of parathyroid adenomas to the correct laterality and pole. 2. Illustrate the advantages of combined Hybrid SPECT/CT and ultrasound imaging in accurately localizing pedunculated upper pole parathyroid adenomas over scintigraphy alone.

Summary: Planar scintigraphy and SPECT have been successfully used to localize parathyroid adenomas to the exact pole. We attempt to demonstrate the added value of using hybrid SPECT/CT combined with ultrasound to accurately localize pedunculated upper pole parathyroid adenomas which may be incorrectly localized to the lower pole by planar or SPECT imaging alone. We also attempt to illustrate the added value of combined SPECT/CT and ultrasound imaging in confirming extratyroidal location of the parathyroid adenomas, further reducing false positive findings in cases of intrathyroidal nodules.