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|Title:||Atlas of Parathyroid Imaging and Pathology|
|Abstract:||To use the same words is not a sufficient guarantee of understanding; one must use the same words for the same genus of inward experience; ultimately one must have one’s experiences in common. –– Friedrich Nietzsche We can rephrase this famous quotation by saying “To use the same radiological study by different radiologic interpreters, or have the same pathological slide evaluated by a different pathologist, is not a sufficient guarantee that the results will be the same regardless of the interpreter. It is the shared experiences of experts in the field that gives the interpreter the ability to be proficient in their field.” This book is designed to highlight this experience and teach the next generation of radiologists, pathologists, endocrinologists, and surgeons the invaluable knowledge of parathyroid imaging and pathology. Over the past 40 years, primary hyperparathyroidism (PHPT) has evolved in its clinical presentation from clinically symptomatic to mildly symptomatic or asymptomatic disease. Indications for the surgical treatment of PHPT were established by the 4th International Workshop for Management and Treatment of Asymptomatic PHPT. Parathyroidectomy is the only curative approach. PHPT is caused by a single parathyroid gland adenoma in 85% of patients and either by multiple adenomas or hyperplasia in all four parathyroid glands in 15% of patients. Preoperative imaging studies are essential, therefore, to localize the parathyroid adenoma and perform successful minimally invasive parathyroidectomy. Several imaging studies are currently used to localize a parathyroid adenoma such as a Sestamibi scan, parathyroid ultrasound, four-dimensional computed tomography (4D CT) scan, and the thin-cut CT scan. Identifying parathyroid adenoma on imaging studies in patients with PHPT is challenging even for experienced radiologists. While the sensitivity of the traditional Sestamibi scan in localization of parathyroid adenoma was only 50%, newer studies such as the SPECT (single-photon emission computerized tomography)/CT Sestamibi scan has sensitivity of about 85–90%. Currently, in addition to the SPECT/CT Sestamibi scan, several newer imaging modalities have been developed, such as thin-cut CT, 4D CT scans, and parathyroid MRI. Newer ultrasound machines are more sensitive and allow for localization of parathyroid adenomas in up to 85% of the cases. Patients with primary hyperparathyroidism have approximately 10% chance of developing recurrent or persistent disease. This may happen due to inability of the surgeon to find a parathyroid adenoma during the first surgery, failure of the surgeon to recognize additional abnormal parathyroid glands, not completely removing the abnormal parathyroid gland by leaving a portion of the parathyroid gland behind, or recurrence of the disease in glands that were previously normal. The recent Guidelines for the Management of Asymptomatic Primary Hyperparathyroidism: Summary Statement from the Fourth International Workshop and the American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism stated that all patients with PHPT would benefit from surgical treatment for PHPT if imaging studies are conclusive in localization of the parathyroid adenoma. Therefore, imaging studies are the standard of care in the treatment of patients with PHPT. They are also crucial for diagnosis and for the surgical recommendation.|
|Appears in Collections:||Parathyroid Glands|
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|39.pdf.pdf||book||44.63 MB||Adobe PDF|
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