"Metabolic Superscan" Pattern in a Case of Secondary Hyperparathyroidism With Parathyroid Hyperplasia Detected on 68 Ga-Trivehexin PET/CT.

Parathyroid hyperplasia frequently causes secondary hyperparathyroidism (SHPT) in chronic kidney disease (CKD), necessitating bilateral neck exploration. Although preoperative imaging is limited, it is essential for reducing recurrent or persistent disease. This case highlights the potential of 68 Ga-trivehexin PET/CT in SHPT, demonstrating better identification of hyperfunctioning parathyroid glands, potentially assisting surgical planning. In addition, diffuse skeletal tracer uptake revealed a "metabolic superscan" pattern consistent with renal osteodystrophy and rapid bone-turnover. 68 Ga-trivehexin PET/CT thus offers promising utility in SHPT for better gland localization and assessment of systemic skeletal involvement.