Four-Dimensional Computed Tomography for Localisation of Parathyroid Adenomas

Primary hyperparathyroidism is a relatively common disorder with a myriad of end-organ manifestations, and surgical treatment remains the only curative option. Minimally invasive parathyroidectomy has replaced bilateral neck exploration as the standard technique for the majority of patients with solitary adenomas. Preoperative imaging is essential for accurate localisation of parathyroid adenomas. Four-dimensional computed tomography of the parathyroids has emerged as a useful problem-solving tool in the initial workup. This article reviews the underlying imaging principles, techniques, and practical tips on image interpretation and reporting, all of which are essential in successful preoperative localisation of parathyroid adenomas.