Localization of Parathyroid Adenoma With 68 Ga-NODAGA-RGD PET/CT and Demonstration of "Metabolic Superscan" With Lincoln Sign and Costochondral Junction Beading : A Potential Clinical Application.

In primary hyperparathyroidism (PHPT), exact preoperative localization of parathyroid adenomas is essential for best surgical planning. While new PET tracers like 18 F-fluorocholine and 68 Ga-Trivehexin show promise, traditional imaging consists of 99m Tc-Sestamibi scintigraphy, SPECT/CT, and 4DCT. Herein, we report the potential new application of another angiogenesis imaging agent, 68 Ga-NODAGA-RGD PET/CT, illustrated in a 12-year-old girl with PHPT. The scan revealed diffuse skeletal tracer uptake (superscan) in addition to localizing right inferior parathyroid adenoma, thereby indicating systemic effects. This case underscores 68 Ga-RGD PET/CT as a possible instrument for parathyroid imaging and systemic evaluation, justifying more research to define its diagnostic value and role in treatment response evaluation.