Four-Dimensional Computed Tomography for Parathyroid Adenoma Localization : A Pre-Operative Imaging Protocol
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.
STUDY DESIGN: 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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:133 |
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| Enthalten in: |
The Annals of otology, rhinology, and laryngology - 133(2024), 4 vom: 06. Feb., Seite 441-448 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Bellamkonda, Nikhil [VerfasserIn] |
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| Links: |
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| Themen: |
4D CT |
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| Anmerkungen: |
Date Completed 27.02.2024 Date Revised 27.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1177/00034894241230353 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM368111202 |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a 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 | ||
| 520 | |a STUDY DESIGN: Retrospective Study | ||
| 520 | |a SETTING: University Hospital | ||
| 520 | |a 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 | ||
| 520 | |a 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% | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a 4D CT | |
| 650 | 4 | |a endocrine surgery | |
| 650 | 4 | |a hyperparathyroidism | |
| 650 | 4 | |a parathyroidectomy | |
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| 700 | 1 | |a Highland, Julie |e verfasserin |4 aut | |
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| 700 | 1 | |a Slattery, Lauren |e verfasserin |4 aut | |
| 700 | 1 | |a King, Brody |e verfasserin |4 aut | |
| 700 | 1 | |a Teames, Charles |e verfasserin |4 aut | |
| 700 | 1 | |a LeBaron, Kaylee |e verfasserin |4 aut | |
| 700 | 1 | |a Wiggins, Richard H |e verfasserin |4 aut | |
| 700 | 1 | |a Abraham, Dev |e verfasserin |4 aut | |
| 700 | 1 | |a Hunt, Jason P |e verfasserin |4 aut | |
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