Which pre-operative imaging modality has the highest sensitivity and specificity for localizing a single parathyroid adenoma in primary hyperparathyroidism, facilitating a minimally invasive parathyroidectomy (MIP)?

• A Tc-99m sestamibi scintigraphy alone
• B High-resolution ultrasonography alone
• C 4D-CT parathyroid scan
• D Tc-99m sestamibi SPECT combined with neck ultrasonography ✓

Explanation

Combining Tc-99m sestamibi SPECT with neck ultrasonography achieves concordant localization in 70–80% of cases and is the standard pre-operative workup before MIP. When both modalities agree on a single gland, MIP with intraoperative PTH monitoring (Miami criterion: >50% drop at 10 minutes) has >95% cure rates. 4D-CT is superior for re-operative or multigland disease. Sestamibi or US alone has lower sensitivity (~60–70% each).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.