Fick's principle-based localization of sporadic primary hyperparathyroidism most commonly involves which imaging modality combination prior to minimally invasive parathyroidectomy?
- A Neck ultrasound + 4D CT scan
- B MRI neck + selective venous sampling
- C Sestamibi SPECT-CT + neck ultrasound ✓
- D PET-CT with 11C-methionine + MRI
Correct answer: C. Sestamibi SPECT-CT + neck ultrasound
Explanation
The standard preoperative localization protocol for sporadic primary hyperparathyroidism prior to focused/minimally invasive parathyroidectomy is 99mTc-sestamibi SPECT-CT combined with neck ultrasound, achieving concordance rates of approximately 80%. When both modalities agree on a single gland, focused parathyroidectomy with intraoperative PTH monitoring is appropriate. 4D CT is used when sestamibi/US are non-concordant. Selective venous sampling is reserved for persistent/recurrent disease. PET with 11C-methionine is an investigational tool.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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