TC-4D como prueba de localización preoperatoria de segunda línea en la evaluación del hiperparatiroidismo primario / 4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism

Introducción: La tomografía computarizada en cuatro dimensiones (TC-4D) ofrece buena sensibilidad para localizar la glándula patológica responsable del hiperparatiroidismo primario. El objetivo fue evaluar su rendimiento como estudio de segunda línea tras ausencia de localización o resultado no concordante de los estudios habituales. Material y métodos: Estudio observacional retrospectivo que incluyó todos los pacientes intervenidos por hiperparatiroidismo primario con TC-4D como estudio preoperatorio, del 1 de octubre de 2016 al 1 de octubre de 2021, en un centro hospitalario de tercer nivel. Se compararon los resultados de la TC-4D, la ecografía y las exploraciones de medicina nuclear (gammagrafía, SPECT y SPECT-TC) con el gold standard de la exploración quirúrgica y el resultado anatomopatológico, analizando los porcentajes de lateralización correcta y localización aproximada de la glándula patológica. Resultados: El análisis incluyó 64 pacientes, con una curación del 93,8% (60/64). La TC-4D mostró una lateralización correcta del 57,8% (37/64) y reveló la localización aproximada de la glándula en el 48,4% (31/64). La ecografía tuvo unos porcentajes del 31,1% (19/61) y del 18% (11/61) para la lateralización correcta y la localización aproximada, respectivamente, vs. un 34,9% (22/63) y un 28,6% (18/63) de los estudios de medicina nuclear y un 32,7% (16/49) y un 24,5% (12/49) de la SPECT-TC. Estas diferencias fueron estadísticamente significativas. Conclusiones: La TC-4D ofrece un rendimiento aceptable para localizar las lesiones responsables del hiperparatiroidismo primario, por lo que debería considerarse su uso ante la ausencia de localización en los estudios habituales. (AU)

Introduction: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. Material and methods: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and nuclear medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. Results: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4D-CT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in nuclear medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. Conclusion: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies. (AU)

4D-CT as a second line preoperative localization test for the evaluation of primary hyperparathyroidism.

INTRODUCTION: Four-dimensional computerized tomography (4D-CT) offers a good sensitivity for the localization of the pathological gland responsible of primary hyperparathyroidism. The aim was to evaluate its results as a second line preoperative localization test after inconclusive or discordant results of usual preoperative studies. MATERIAL AND METHODS: Observational retrospective study that included all patients intervened for primary hyperparathyroidism with 4D-CT scan as preoperative study, from 1st October 2016 to 1st October 2021, in a tertiary referral centre. The results of 4D-CT, cervical ultrasound, and Nuclear Medicine explorations (scintigraphy, SPECT and SPECT-CT) were compared with the gold standard of the surgical exploration and the pathological result. The correct lateralization and the approximate localization rates of the pathological gland were evaluated. RESULTS: A total of 64 patients were analysed, with a 93,8% (60/64) remission rate. 4DCT showed a correct lateralization in 57,8% (37/64) of the cases and revealed the approximate localization of the gland in 48,4% (31/64) of the cases. The cervical ultrasound had a rate of 31,1% (19/61) and 18% (11/61) for the correct lateralization and approximate localization, respectively, compared to 34,9% (22/63) and 28,6% (18/63) in Nuclear Medicine explorations, and 32,7% (16/49) and 24,5% (12/49) in SPECT-CT. These differences were statistically significant. CONCLUSION: 4D-CT demonstrated acceptable results for the localization of the lesions responsible of primary hyperparathyroidism, thus its use should be considered with the absence of localization in routinely studies.