Localization of the parathyroid adenoma in mibi-negative cases: The value of a dedicated sonologist

Sestamibi (MIBI) scintigraphy combined with the single photon emission computed tomography (SPECT) is the initial test of choice in all cases, as it is the best test to screen both the cervical and mediastinal lesions and has the highest positive predictive value of the available imaging techniques. [3] Doubtful lesions and intra-thyroidal lesions can be assessed with needle aspirate parathyroid hormone (PTH) which can accurately localize an intra-thyroidal parathyroid adenoma. Unlike the nuclear imaging or cross-sectional imaging which give a binary localizing result as adenoma present or absent, the US report by a dedicated sonologist can give a map of the suspected lesions present within the thyroid gland and outside the thyroid gland [Figure 3].