Four-Dimensional Computed Tomography for Parathyroid Adenoma Localization: A Pre-Operative Imaging Protocol.
Ann Otol Rhinol Laryngol
; 133(4): 441-448, 2024 Apr.
Article
in En
| MEDLINE
| ID: mdl-38321924
ABSTRACT
OBJECTIVE:
Primary hyperparathyroidism (PHPT) affects approximately 0.86% of the population, with surgical resection as the treatment of choice. A 4D computed tomography (CT) is a highly effective tool in localizing parathyroid adenomas; however, there is currently no defined role for 4D CT when stratified against ultrasonography (USG) and nuclear medicine Technetium Sestamibi SPECT/CT (SES) imaging. STUDYDESIGN:
Retrospective Study.SETTING:
University Hospital.METHODS:
All patients who underwent parathyroidectomy for PHPT between 2014 and 2019 at a single institution were reviewed. Patients who had a 4D CT were included. We compared outcomes of 4D CT as a second line imaging modality to those of USG and SES as first line modalities. An imaging algorithm was proposed based on these findings.RESULTS:
There were 84 patients identified who had a 4D CT after unsuccessful first line imaging. A 4D CT localized parathyroid adenoma to the correct quadrant in 64% of cases, and to the correct laterality in 75% of cases. Obese patients had significantly lower rates of adenoma localization with USG (33.4%), compared to non-obese patients (67.5%; P = .006). In determining multigland disease the sensitivity of 4D CT was 86%, while the specificity was 87%.CONCLUSIONS:
A 4D CT has impressive rates of accurate localization of parathyroid adenomas; however due to the radiation exposure involved, it should remain a second line imaging modality. PHPT patients should first be evaluated with USG, with 4D CT used if this is unsuccessful and patients are greater than 40 years old, have a high BMI, or are having revision surgery.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Parathyroid Neoplasms
/
Hyperparathyroidism, Primary
Type of study:
Observational_studies
/
Prognostic_studies
Limits:
Adult
/
Humans
Language:
En
Journal:
Ann Otol Rhinol Laryngol
/
Ann. otol. rhinol. laryngol
/
Annals of otology, rhinology and laryngology
Year:
2024
Document type:
Article
Affiliation country:
Estados Unidos
Country of publication:
Estados Unidos