Recent advances in parathyroid imaging.

Although no existing imaging procedure is as effective as an experienced surgeon for locating abnormal parathyroid glands in patients without previous neck surgery, preoperative parathyroid localization is considered essential for patients undergoing reoperations. The need for parathyroid imaging in patients undergoing an initial exploration remains controversial. Scintigraphy with (99m)Tc-sestamibi has largely replaced (99m)Tc-pertechnetate/(201)Tl chloride subtraction scintigraphy for parathyroid imaging because of its superior sensitivity and false-positive rate. Positron emission tomography, another technique recently applied to parathyroid imaging, is of uncertain value at present.