Radiologic localization of parathyroid adenomas in the previously operated patient; Part II: Invasive localization procedures

The authors studied intraarterial digital subtraction angiography (DSA), conventional selective angiography (CA), parathyroid venous sampling (PVS), and intraoperative US as localization procedures in 53 patients with proved parathyroid adenomas and in whom parathyroid surgery had been unsuccessful. PVS had the highest overall sensitivity (80%), followed by intraoperative US (78%), CA (61%), and DSA (49%). Invasive procedures successfully localized adenomas in 41 of 43 patients (95%). False positive studies were uncommon. The optimum sequence of invasive procedures to localize parathyroid adenoma is determined by clinical factors. The authors recommend DSA first, followed by CA, PVS, and intraoperative US. All of the invasive localization procedures they studied are valuable