4D CT Parathyroid for the General Radiologist: A Pictorial Essay of Illustrative Cases

Abstract Primary hyperparathyroidism is a morbid disease that affects multiple organ systems and causes a multitude of debilitating symptoms if not properly diagnosed and treated. Minimally invasive parathyroidectomy is now the standard of care for the treatment of primary hyperparathyroidism. In the hands of experienced high-volume surgeons, the success rate of this treatment is approximately 95%. Preoperative planning with four-dimensional computed tomography (4DCT) is becoming increasingly common as a first line imaging modality. It is important for general radiologists to become familiar with this type of study in order to better assist their surgical colleagues. This image-rich review will discuss hyperparathyroidism, benefits and weaknesses of different imaging modalities, 4DCT imaging protocol, relevant anatomy, expected appearance and location of parathyroid adenomas, ectopic and atypical appearances, multi-gland disease and important mimics.