A patient is planned for re-do parathyroid surgery for persistent primary hyperparathyroidism after failed neck exploration. The most sensitive localisation modality for ectopic or supernumerary parathyroid adenoma prior to re-operation is:

• A 4D-CT (four-dimensional CT protocol)
• B Sestamibi scintigraphy (99mTc-MIBI) alone
• C Ultrasound of neck
• D PET-CT with 18F-fluorocholine ✓

Explanation

18F-fluorocholine PET-CT has emerged as the most sensitive modality for localising ectopic, supernumerary, or small parathyroid adenomas in re-operative cases where sestamibi and 4D-CT have failed or are discordant. Studies report detection rates of 80–90% in re-do cases. 4D-CT and sestamibi are useful first-line tools for initial exploration, but fluorocholine PET-CT is superior in the challenging re-operative setting due to higher spatial resolution and molecular targeting of parathyroid tissue.

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.