Accurate preoperative anatomic localization of hyperfunctioning parathyroid adenoma (HTP) critical importance in surgical planning for minimally invasive parathyroidectomy. SPECT/CT with 99mTc-sestamibi (99mTc-MIBI) important for detection of any metabolic active hyperfunctioning gland(s) localized in the neck or mediastinum. Ultrasonography (US) and Four-dimensional parathyroid CT (4D CT) increasingly offers potential advantages as an alternative primary investigation and is a common second-line investigation.

Retrospective study included 28 patients aged 26 - 87 years (mean age 49±7). Female to male ratio was 4:1. The follow-up period ranged from 3 to12 months, the mean being 6 months. In all cases of biochemically confirmed hyperparathyroidism, the average levels were: Ca total - 2.65±0.05mmol/l (NV 2.12-2,52), PTH=72±32pg/ml (NV 1.5-9.2). All underwent parathyroidectomy, and an adenoma was confirmed. Scintigraphy was performed with SPECT/CT (GE model 670pro NM/CT). 4D CT done with Toshiba aquilion 64‬‏. Ultrasonography (US) was done with ACUSON SC2000 by means of 10MHz linear probe.

The exact localization hyperfunctioning parathyroid gland was identified 23 (82.2%) out of 28 patients by means of SPECT/CT. The remaining 5 patients need an alternative investigation and second-line investigation which we started with US parathyroid adenomia was identified 2 (40%) out of 5 patients. All remaining 5 patients further invastigated with 4D-parathyroid CT scan hyperfunctioning parathyroid gland was identified 4 (80%) out of 5 patients. One patients (3.5%) out of 28 patients was dignosed intraoperatively.

SPECT/CT with 99mTc-sestamibi appears promising with an important key role in diagnosis hyperfunctioning parathyroid gland but further imaging with 4D-parathyroid CT scan may needed particularly when we attempting to diagnose the precise site of disease localization in presurgical planning.

An integrated diagnostic approach based on scintigraphy and high-resolution neck ultrasound was extremely accurate  of identifying patients with  parathyroid lesions before surgery, enabling them to undergo limited surgery, 4DCT scan analysis may be useful in some patients with suspected parathyroid adenoma localised in a deep seat, allowing a more precise identification of the latter and better surgical planning.

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