Localization of Ectopic Hyperparathyroidism: Ultrasound Versus ^99mTc-sestamibi, 4-Dimensional Computed Tomography, and ¹¹C-choline Positron Emission Tomography/Computed Tomography

Objective: To investigate the usefulness of ultrasound (US) for the localization of ectopic hyperparathyroidism and compare it with Tc-99m-sestamibi (Tc-99m-MIBI), 4-dimensional computed tomography (4D-CT), and C-11-choline positron emission tomography/ computed tomography (PET/CT). Methods: Of the 527 patients with surgically confirmed primary hyperparathyroidism, 79 patients with ectopic hyperparathyroidism were enrolled. The diagnostic performance of US, Tc-99m-MIBI, US + MIBI, 4D-CT, and C-11-choline PET/CT was calculated, and the factors affecting the sensitivity of US and Tc-99m-MIBI were analyzed. Results: Eighty-three ectopic parathyroid lesions were found in 79 patients. The sensitivity was 75.9%, 81.7%, 95.1%, 83.3%, and 100% for US, 99mTc-MIBI, US + MIBI, 4D-CT, and C-11-choline PET/CT, respectively. The difference in sensitivity among these different modalities did not achieve statistical significance (P > .05). The US sensitivity was significantly higher for ectopic lesions in the neck region than for those in the anterior mediastinum/chest wall (85.9% vs. 42.1%, P < .001). The Tc-99m-MIBI and 4D-CT sensitivity was not significantly different between these two groups (84.1% vs. 94.6%, P = .193 and 81.3% vs. 85.7%, P = 1). The C-11-choline PET/CT sensitivity was 100% in both groups. Conclusions: US is a valuable tool for the localization of ectopic hyperparathyroidism, especially forectopic lesions in the neck region. (c) 2023 AACE. Published by Elsevier Inc. All rights reserved.