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Role of the Radiologist in the Preoperative Evaluation of Primary Hyperparathyroidism

AMNCH Tallaght Hospital, Dublin, Ireland

 
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We read with great interest the excellent article by Johnson et al. [1], "Parathyroid Imaging: Technique and Role in the Preoperative Evaluation of Primary Hyperparathyroidism," published in the June issue of the AJR. The authors present a comprehensive review of the role the radiologist has in the preoperative evaluation of primary hyperparathyroidism.

The article [1] is comprehensive; however, we think that the radiologist has a further role in localizing difficult parathyroid lesions by the addition of venous sampling. Although modern cross-sectional imaging has decreased the necessity for venous sampling, it still plays a role in situations in which a lesion is difficult to visualize or when it is uncertain whether a visualized lesion represents an ectopic parathyroid lesion or a lymph node. In such cases, selective venous sampling can be invaluable in localizing or distinguishing an adenoma from a lymph node [2]. One reason that venous sampling has declined in popularity is that many radiologists find it difficult to obtain blood samples from small veins in the neck. However, techniques for venous extraction have improved. In our department, we routinely use a coaxial microwire system, which aids venous sampling and permits superselective catheterization [3].

In summary, we compliment the authors on an excellent article; however, we think that the radiologist should not forget the important contribution venous sampling may make in localizing parathyroid lesions.

References

Top References

 

1. Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR 2007; 188:1706 -1715[Abstract/Free Full Text]
2. Dunlop DA, Papapoulos SE, Lodge RW, Fulton AJ, Kendall BE, O'Riordan JL. Parathyroid venous sampling: anatomic considerations and results in 95 patients with primary hyperparathyroidism. Br J Radiol 1980; 53:183 -191[Abstract/Free Full Text]
3. Buckley O, O'Brien J, Doody O, Torreggiani WC. A novel technique in selective venous sampling in the localization of parathyroid tumours utilizing a micro-wire and standardized catheter. Eur Radiol2007; 17:1125 -1127[CrossRef][Medline]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Buckley, O. Articles by Torreggiani, W. C. Search for Related Content PubMed PubMed Citation Articles by Buckley, O. Articles by Torreggiani, W. C. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?