Clinical Importance and Evolving Applications of Parathyroid Scintigraphy

Parathyroid scintigraphy, primarily using 99mTc-sestamibi, is a cornerstone imaging modality for localizing hyperfunctioning parathyroid glands in primary, secondary, and tertiary hyperparathyroidism. Accurate preoperative localization facilitates minimally invasive parathyroidectomy and reduces surgical morbidity. Advances such as SPECT/CT integration, dual-tracer subtraction techniques, and artificial intelligence-assisted interpretation have significantly improved diagnostic accuracy, especially in complex or equivocal cases. Scintigraphy offers unique advantages in detecting ectopic glands and guiding re-operative surgery, although sensitivity declines in multigland disease or small adenomas. Complementary modalities, including high-resolution ultrasound, 4D-CT, and emerging PET tracers like 18F-fluorocholine, can enhance localization in challenging scenarios. Future developments—ranging from novel tracers to hybrid imaging and intraoperative guidance tools—are expected to further refine diagnostic pathways. Despite the growing role of alternative modalities, 99mTc-sestamibi scintigraphy remains the gold standard, valued for its functional mapping capabilities and enduring clinical utility in tailored surgical planning.