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The Essentials of Parathyroid Hormone Venous Sampling

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Abstract

Hyperparathyroidism is an excess of parathyroid hormone in the blood due to over-activity of one or more parathyroid gland. Localization of abnormal glands with noninvasive imaging modalities, such as technetium sestamibi scan and cross-sectional imaging, has a high success rate. Parathyroid venous sampling is performed for patients with persistent or recurrent disease after previous parathyroid surgery, when repeat noninvasive imaging studies are negative or discordant. The success of invasive localization studies and results interpretation is dependent on the interventional radiologist’s understanding of the normal and ectopic anatomic locations of parathyroid glands, as well as their blood supply and venous drainage. Anatomic and technical considerations for selective parathyroid venous sampling are reviewed.

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Abbreviations

4DCT:

4-dimensional computed tomography

IJ:

Internal jugular

IMA:

Internal mammary artery

IMV:

Internal mammary vein

IVC:

Inferior vena cava

MEN:

Multiple endocrine neoplasia

MIP:

Minimally invasive parathyroidectomy

MRI:

Magnetic resonance imaging

PHPT:

Primary hyperparathyroidism

PPV:

Positive predictive value

PTH:

Parathyroid hormone

PVS:

Parathyroid venous sampling

SPECT:

Single-photon emission computed tomography

SVC:

Superior vena cava

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Authors and Affiliations

  1. Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, NY, USA

    Bedros Taslakian

  2. Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA

    Scott O. Trerotola

  3. Department of Interventional Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Barry Sacks

  4. Department of Interventional Radiology, Mayo Clinic, Scottsdale, AZ, USA

    Rahmi Oklu

  5. Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA

    Amy Deipolyi

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  1. Bedros Taslakian
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  2. Scott O. Trerotola
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  3. Barry Sacks
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Correspondence to Amy Deipolyi.

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Dr. Trerotola reports personal fees and other from Teleflex, personal fees and other from Cook, personal fees from MedComp, personal fees from WL Gore, personal fees from B Braun, personal fees from Lutonix, personal fees from Bard Peripheral Vascular, personal fees from Orbimed, grants from Vascular Pathways, outside the submitted work. All other authors (B. T., B. S., R. O., and A. D): No conflict of interest.

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Taslakian, B., Trerotola, S.O., Sacks, B. et al. The Essentials of Parathyroid Hormone Venous Sampling. Cardiovasc Intervent Radiol 40, 9–21 (2017). https://doi.org/10.1007/s00270-016-1481-4

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