Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Figure 8

Parathyroid adenomas on magnetic resonance imaging (MRI). A 67-year-old female presents with persistent hyperparathyroidism after initial bilateral inferior parathyroidectomy. Unenhanced MRI (due to allergy to iodine- and gadolinium-based contrast materials) shows well-circumscribed bilateral inferior T2WI hyperintense (a) and T1WI hypointense (b) adenomas (white arrows) posterior to the inferior thyroid lobes. Planar delayed (two hours) single-photon emission computed tomography (SPECT) (c) demonstrates focal radiotracer accumulation (white arrows) along the inferior margin of the thyroid lobes. Further review of the MRI reveals small T2WI hyperintense (d) and poorly defined T1WI hypointense (e) nodules in the left posterior mediastinum/prevertebral region corresponding to an overly descended left superior parathyroid adenoma not demonstrated on initial SPECT studies (c, f).

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