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Hamidi M, Sullivan M, Hunter G, Hamberg L, Cho NL, Gawande AA, Doherty GM, Moore FD, Nehs MA. 4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease. Ann Surg Oncol 2018; 25:1403-1409. [PMID: 29484563 DOI: 10.1245/s10434-018-6367-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Recurrent primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localizing a hyperfunctioning gland. Although several imaging modalities are available for preoperative localization, 4D-CT is increasingly utilized for its ability to locate both smaller and previously unlocalized lesions. Currently, there is a paucity of data evaluating the utility of 4D-CT in the reoperative setting compared with ultrasound (US) and sestamibi. We aimed to determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent PHPT. METHODS We performed a retrospective review of prospectively collected data from a tertiary-care hospital, and identified 58 patients who received preoperative 4D-CT with US and/or sestamibi between May 2008 and March 2016. Data regarding the size, shape, and number of parathyroid lesions were collected for each patient. RESULTS A total of 62 lesions were identified intraoperatively among the 58 patients (6 with multigland disease) included in this investigation. 4D-CT missed 13 lesions identified intraoperatively, compared with 32 and 22 lesions missed by US and sestamibi, respectively. Sensitivity for correct lateralization of culprit lesions was 77.4% for 4D-CT, 38.5% for US, and 46% for sestamibi. 4D-CT was superior in lateralizing adenomas (49/62) compared with US (20/52; p < 0.001) and sestamibi (18/47; p < 0.001). The overall cure rate (6-month postoperative calcium < 10.7 mg/dL) was 89.7%. All patients with lesions correctly lateralized by 4D-CT were cured at 6 months. CONCLUSION 4D-CT localized parathyroid adenomas with higher sensitivity among patients with recurrent or persistent PHPT compared with sestamibi or US-based imaging.
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Affiliation(s)
- Moska Hamidi
- Division of General Surgery, London Health Sciences Center, London, ON, Canada
| | - Michael Sullivan
- Division of General Surgery, Jersey Shore University Medical Center, Neptune City, NJ, USA
| | - George Hunter
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Leena Hamberg
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Nancy L Cho
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Atul A Gawande
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Gerard M Doherty
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Francis D Moore
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew A Nehs
- Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA. .,General and Endocrine Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Goroshi M, Lila AR, Jadhav SS, Sonawane S, Hira P, Goroshi S, Garle MN, Dalvi A, Sathe P, Bandgar TR, Shah NS. Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma/hyperplasia in primary hyperparathyroidism. Clin Endocrinol (Oxf) 2017; 87:791-798. [PMID: 28656592 DOI: 10.1111/cen.13406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/05/2017] [Accepted: 06/20/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Radiation exposure to neck by four-dimensional computerized tomography (4DCT) is relatively high and limits its use as a first-line investigation in evaluation of primary hyperparathyroidism (PHPT). Radiation exposure can be reduced by restricting the number of CT phases. Our aim was to study the performance of 4DCT in cohort of surgery-naïve PHPT patients, and to evaluate percentage enhancement as an objective radiological index to discriminate parathyroid lesions (adenoma/hyperplasia) from thyroid tissue and lymph nodes. MATERIALS AND METHOD Retrospective study of 49 PHPT patients {(44 single-gland diseases (SGD) and five multiple-gland disease (MGD)} who underwent 4DCT (unenhanced, early arterial, early venous and delayed venous phase) pre-operatively. Two radiologists who were blinded to surgical location of parathyroid lesions examined the scans. Attenuation values were recorded for parathyroid lesions (n=50), thyroid gland (n=50) and lymph nodes (n=12) in different phases. Percentage enhancement for different phases was calculated as "(HU in a specific enhanced phase-HU in unenhanced phase)/HU in unenhanced phase" ×100. RESULTS Inter-rater reliability between the two radiologists was 0.83 (Cohen's kappa). In SGD, sensitivity and PPV were 93.18% and 98.8% for lateralization, and 89.77% and 95.18% for quadrant localization, respectively. In MGD, 4DCT showed 50% sensitivity and 100% PPV. Percentage arterial enhancement showed highest area under curve (AUC=0.992) for differentiation of parathyroid lesions from thyroid tissue and lymph nodes. A cut-off value of 128.9% showed 95.8% sensitivity and 100% specificity for the identification of parathyroid lesions. CONCLUSIONS We propose that percentage arterial enhancement can be used as an objective radiological index for accurate identification of parathyroid adenoma/hyperplasia.
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Affiliation(s)
- Manjunath Goroshi
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Anurag R Lila
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Swati S Jadhav
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Sushil Sonawane
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Priya Hira
- Department of Radiology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Shetteppa Goroshi
- Department of Radiology, Sri Nijalingappa Medical College Bagalkot, Bagalkot, India
| | - Mahadev N Garle
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Abhay Dalvi
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Pragati Sathe
- Department of Pathology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Tushar R Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Nalini S Shah
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Abstract
Primary hyperparathyroidism (PHPT) is characterized by excessive, dysregulated production of parathyroid hormone (PTH) by 1 or more abnormal parathyroid glands. Minimally invasive surgical techniques have created a need for more precise localization of the parathyroid lesion by imaging. A variety of imaging protocols and techniques have been used for this purpose, but no one modality is clearly superior. Nuclear medicine scintigraphy and ultrasound imaging are established modalities, although multiphase or 4-dimensional computed tomography is an emerging modality with several advantages. This review provides a background regarding PHPT and key anatomy, and discusses these alternative parathyroid imaging modalities with updates.
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Affiliation(s)
- Samuel J Kuzminski
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, College of Medicine, PO Box 2690, Garrison Tower, Suite 4G4250, Oklahoma City, OK 73126, USA
| | - Julie A Sosa
- Department of Surgery, Duke University, Duke University Medical Center, Box 2945, Durham, NC 27710, USA
| | - Jenny K Hoang
- Department of Radiology, Duke University, Duke University Medical Center, Box 3808, Erwin Road, Durham, NC 27710, USA.
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Frank SJ, Goldman-Yassen AE, Koenigsberg T, Libutti SK, Koenigsberg M. Sensitivity of 3-Dimensional Sonography in Preoperative Evaluation of Parathyroid Glands in Patients With Primary Hyperparathyroidism. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1897-1904. [PMID: 28543268 DOI: 10.1002/jum.14245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/06/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism facilitates targeted surgery. We assessed the sensitivity of 3-dimensional (3D) sonography for preoperative localization of abnormal parathyroid glands. METHODS We conducted a retrospective review of patients who underwent parathyroidectomy for primary hyperparathyroidism at a single site at our institution. We compared preoperative 2-dimensional (2D) sonography, 3D sonography, and sestamibi scans with final gland localization at surgery. Two readers reviewed the sonograms to assess inter-reader variability. RESULTS From January 2010 through April 2015, 52 patients underwent parathyroidectomy after preoperative 2D sonography, 3D sonography, and sestamibi scans. Three-dimensional sonography had sensitivity of 88-92% compared with 69-71% for 2D sonography for gland localization. In patients in whom sonography and sestamibi scans localized abnormalities to the same side, the sensitivities were 100% (43 of 43) for 3D sonography and 96% (48 of 50) for 2D sonography. Three-dimensional sonography had significantly higher sensitivity for localization of glands smaller than 500 mg compared with 2D sonography (88% versus 58%; P = .012). There was better inter-reader agreement between the radiologists when using 3D sonography (κ = 0.65) compared with 2D sonography (κ = 0.41). CONCLUSIONS We found a significantly higher sensitivity and better inter-reader agreement for 3D sonography compared with 2D sonography for preoperative identification of abnormal parathyroid glands, especially among smaller glands.
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Affiliation(s)
- Susan J Frank
- Departments of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Tova Koenigsberg
- Departments of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | - Steven K Libutti
- Departments of Surgery, Montefiore Medical Center, Bronx, New York, USA
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Morón F, Delumpa A, Chetta J, Guffey D, Dunaway D. Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: a retrospective review. PeerJ 2017; 5:e3586. [PMID: 28828238 PMCID: PMC5562135 DOI: 10.7717/peerj.3586] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/27/2017] [Indexed: 01/06/2023] Open
Abstract
Objective This study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism. Methods The CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas. Results The parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p = 0.695). These results are similar to those found in the literature for multiphase CT of 55–94%. Conclusions Our study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: a single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.
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Affiliation(s)
- Fanny Morón
- Radiology, Baylor College of Medicine, Houston, TX, United States of America
| | - Alfred Delumpa
- Radiology, Baylor College of Medicine, Houston, TX, United States of America
| | - Justin Chetta
- Radiology, Baylor College of Medicine, Houston, TX, United States of America
| | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States of America
| | - David Dunaway
- Radiology, Baylor College of Medicine, Houston, TX, United States of America
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4D-CT for Detection of Parathyroid Adenomas and Hyperplasia: State of the Art Imaging. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0198-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Dual-Energy CT Characteristics of Parathyroid Adenomas on 25-and 55-Second 4D-CT Acquisitions: Preliminary Experience. J Comput Assist Tomogr 2017; 40:806-14. [PMID: 27224226 DOI: 10.1097/rct.0000000000000442] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to compare the dual-energy computed tomography (CT) characteristics of parathyroid adenomas (PAs), thyroid tissue, and lymph nodes (LNs) and assess whether the spectral information can improve distinction of these tissues. METHODS Dual-energy CT scans from 20 patients with pathologically proven PAs were retrospectively evaluated, identifying 19 eligible PAs and region of interest analysis used for spectral characterization. RESULTS There was a significant difference in multiple spectral parameters between PAs, LNs, and the thyroid gland (P < 0.05-0.0001). The greatest difference in spectral characteristics of PAs compared with that of LNs was on the 25-second acquisition, whereas the 55-second acquisition was better for distinguishing PAs from the thyroid gland. CONCLUSIONS Four-dimensional CT acquired in dual-energy CT mode has the potential to further enhance diagnostic accuracy for PA identification on individual phases of the perfusion study.
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Park JE, Lee JH, Ryu KH, Park HS, Chung MS, Kim HW, Choi YJ, Baek JH. Improved Diagnostic Accuracy Using Arterial Phase CT for Lateral Cervical Lymph Node Metastasis from Papillary Thyroid Cancer. AJNR Am J Neuroradiol 2017; 38:782-788. [PMID: 28126748 DOI: 10.3174/ajnr.a5054] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 11/05/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced CT protocols for papillary thyroid cancer are yet to be optimized. Our aim was to compare the diagnostic accuracy of arterial phase CT and delayed-phase CT protocols for lateral cervical lymph node metastasis from papillary thyroid carcinoma by using the lymph node tissue attenuation. MATERIALS AND METHODS This retrospective study included 327 lateral cervical lymph nodes (177 metastatic and 150 benign) from 131 patients with papillary thyroid carcinoma (107 initially diagnosed and 24 recurrences). Patients underwent CT by using 1 of 3 protocols: a 70-second (A) or a 35-second (B) delay with 100 mL of iodinated IV contrast or a 25-second delay with 75 mL of IV contrast (C). Two readers independently measured and compared lymph node tissue attenuation between metastatic and benign lymph nodes. An area under the receiver operating characteristic curve analysis was performed to differentiate metastatic and benign lymph nodes after multiple comparison correction for clustered data and was compared across the protocols. RESULTS The difference in mean lymph node tissue attenuation between metastatic and benign lymph nodes was maximum in protocol C (P < .001 for both readers). Protocol C showed the highest diagnostic performance (area under the receiver operating characteristic curve, 0.88-0.92) compared with protocol A (area under the receiver operating characteristic curve, 0.73-0.74, P < .001 for both readers) and B (area under the receiver operating characteristic curve, .63-0.65, P < .01 for both readers). The sensitivity, specificity, positive predictive value, and negative predictive value of lymph node tissue attenuation by using a 99-HU cutoff value were 83%-87%, 93.7%-97.9%, 95.1%-97.3%, and 81.2%-87%. CONCLUSIONS A combination of 25-second delay CT and 75 mL of iodinated IV contrast can improve the diagnostic accuracy for lateral lymph node metastasis from papillary thyroid carcinoma compared with a combination of a 35- or 70-second delay with 100-mL of iodinated IV contrast.
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Affiliation(s)
- J E Park
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J H Lee
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - K H Ryu
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - H S Park
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - M S Chung
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - H W Kim
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Y J Choi
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - J H Baek
- From the Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kluijfhout WP, Pasternak JD, Beninato T, Drake FT, Gosnell JE, Shen WT, Duh QY, Allen IE, Vriens MR, de Keizer B, Hope TA, Suh I. Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis. Eur J Radiol 2017; 88:117-128. [PMID: 28189196 DOI: 10.1016/j.ejrad.2017.01.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/02/2016] [Accepted: 01/03/2017] [Indexed: 01/02/2023]
Abstract
PURPOSE To perform a systematic review and meta-analysis of the sensitivity and positive predictive value (PPV) of CT for preoperative parathyroid localization in patients with primary hyperparathyroidism (pHPT), and subsequently compare the different protocols and their performance in different patient groups. MATERIALS AND METHODS We performed a search of the Embase, Pubmed and Cochrane Library databases to identify studies published between January 1, 2000 and March 31, 2016 investigating the diagnostic value of CT for parathyroid localization in patients with biochemical diagnosis of pHPT. Performance of CT was expressed in sensitivity and PPV with pooled proportion using a random-effects model. Factors that could have affected the diagnostic performance were investigated by subgroup analysis. RESULTS Thirty-four studies evaluating a total of 2563 patients with non-familial pHPT who underwent CT localization and surgical resection were included. Overall pooled sensitivity of CT for localization of the pathological parathyroid(s) to the correct quadrant was 73% (95% CI: 69-78%), which increased to 81% (95% CI: 75-87%) for lateralization to the correct side. Subgroup analysis based on the number of contrast phases showed that adding a second contrast phase raises sensitivity from 71% (95% CI: 61-80%) to 76% (95% CI: 71-87%), and that adding a third phase resulted in a more modest additional increase in performance with a sensitivity of 80% (95% CI: 74-86%). CONCLUSION CT performs well in localizing pathological glands in patients with pHPT. A protocol with two contrast phases seems to offer a good balance of acceptable performance with limitation of radiation exposure.
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Affiliation(s)
- Wouter P Kluijfhout
- Department of Surgery, University of California San Francisco, United States; Department of Surgery, University Medical Center Utrecht, The Netherlands.
| | | | - Toni Beninato
- Department of Surgery, University of California San Francisco, United States
| | | | - Jessica E Gosnell
- Department of Surgery, University of California San Francisco, United States
| | - Wen T Shen
- Department of Surgery, University of California San Francisco, United States
| | - Quan-Yang Duh
- Department of Surgery, University of California San Francisco, United States
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, USA
| | - Menno R Vriens
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Bart de Keizer
- Department of Radiology, University Medical Center Utrecht, The Netherlands
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, USA
| | - Insoo Suh
- Department of Surgery, University of California San Francisco, United States
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Matthews C, Matthews A, Safavi K. Clinical Images: Four-Dimensional Computed Tomography-Future of Preoperative Parathyroid Adenoma Imaging. Ochsner J 2017; 17:220-222. [PMID: 29026351 PMCID: PMC5625977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Affiliation(s)
- Charles Matthews
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Andrew Matthews
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
| | - Kurosh Safavi
- Department of Radiology, Ochsner Clinic Foundation, New Orleans, LA
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Sho S, Yilma M, Yeh MW, Livhits M, Wu JX, Hoang JK, Sepahdari AR. Prospective Validation of Two 4D-CT-Based Scoring Systems for Prediction of Multigland Disease in Primary Hyperparathyroidism. AJNR Am J Neuroradiol 2016; 37:2323-2327. [PMID: 27659191 DOI: 10.3174/ajnr.a4948] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 06/11/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Patients with multigland primary hyperparathyroidism are at higher risk for missed lesions on imaging and failed parathyroidectomy. The purpose of this study was to prospectively validate the ability of previously derived predictive score systems, the composite multigland disease score, and the multiphase multidetector contrast-enhanced CT (4D-CT) composite multigland disease score, to identify patients with a high likelihood of multigland disease. MATERIALS AND METHODS This was a prospective study of 71 patients with primary hyperparathyroidism who underwent 4D-CT and successful parathyroidectomy. The size and number of lesions identified on 4D-CT, serum calcium levels, and parathyroid hormone levels were collected. A composite multigland disease score was calculated from 4D-CT imaging findings and the Wisconsin Index (the product of the serum calcium and parathyroid hormone levels). A 4D-CT multigland disease score was obtained by using the CT data alone. RESULTS Twenty-eight patients with multigland disease were compared with 43 patients with single-gland disease. Patients with multigland disease had a significantly smaller lesion size (P < .01) and a higher likelihood of having either ≥2 or 0 lesions identified on 4D-CT (P < .01). Composite multigland disease scores of ≥4, ≥5, and 6 had specificities of 72%, 86%, and 100% for multigland disease, respectively. 4D-CT multigland disease scores of ≥3 and 4 had specificities of 74% and 88%. CONCLUSIONS Predictive scoring systems based on 4D-CT data, with or without laboratory data, were able to identify a subgroup of patients with a high likelihood of multigland disease in a prospectively accrued population of patients with primary hyperparathyroidism. These scoring systems can aid in surgical planning.
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Affiliation(s)
- S Sho
- From the Department of Surgery (S.S., M.Y., M.W.Y., M.L., J.X.W.), Section of Endocrine Surgery
| | - M Yilma
- From the Department of Surgery (S.S., M.Y., M.W.Y., M.L., J.X.W.), Section of Endocrine Surgery
| | - M W Yeh
- From the Department of Surgery (S.S., M.Y., M.W.Y., M.L., J.X.W.), Section of Endocrine Surgery
| | - M Livhits
- From the Department of Surgery (S.S., M.Y., M.W.Y., M.L., J.X.W.), Section of Endocrine Surgery
| | - J X Wu
- From the Department of Surgery (S.S., M.Y., M.W.Y., M.L., J.X.W.), Section of Endocrine Surgery
| | - J K Hoang
- Department of Radiology (J.K.H.), Duke University Medical Center, Durham, North Carolina
| | - A R Sepahdari
- Department of Radiological Sciences (A.R.S.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Vahabzadeh-Hagh AM, Zipser BD, Tan HT, Hong AY, Clair JMS, Armin BB. More than just tissue diagnosis in a patient with maxillofacial bony lesions and hypercalcemia. Laryngoscope 2016; 127:1318-1321. [PMID: 27641155 DOI: 10.1002/lary.26300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 12/19/2022]
Abstract
Brown tumors are a definitive feature of hyperparathyroidism. They are well-demarcated osteolytic lesions commonly in the appendicular skeleton. Primary hyperparathyroidism is typically suggested by hypercalcemia and hypophosphatemia on routine labs. Much more rarely do these cases present with a craniofacial mass. Here we investigate a unique presentation of terminal stage primary hyperparathyroidism with a growing maxillary mass emphasizing the importance of a broad differential diagnosis and key diagnostic studies. Hyperparathyroidism can present in very unique ways. As otolaryngologists in the frontline, we must think beyond just tissue diagnoses so that appropriate and expedited care may be implemented. Laryngoscope, 127:1318-1321, 2017.
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Affiliation(s)
- Andrew M Vahabzadeh-Hagh
- Department of Head and Neck Surgery , University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Brian D Zipser
- Department of Radiology , Olive-View University of California Los Angeles Medical Center, Sylmar, California, U.S.A
| | - Hongying T Tan
- Department of Pathology and Clinic Labs , Olive-View University of California Los Angeles Medical Center, Sylmar, California, U.S.A
| | - Austin Y Hong
- Department of Head and Neck Surgery , University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Jon Mallen-St Clair
- Department of Head and Neck Surgery , University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A
| | - Bob B Armin
- Department of Head and Neck Surgery , University of California Los Angeles, David Geffen School of Medicine, Los Angeles, California, U.S.A
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Hoang JK, Williams K, Gaillard F, Dixon A, Sosa JA. Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends. Otolaryngol Head Neck Surg 2016; 155:956-960. [PMID: 27329424 DOI: 10.1177/0194599816655311] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 05/19/2016] [Accepted: 05/27/2016] [Indexed: 12/13/2022]
Abstract
Four-dimensional computed tomography (4D-CT) is a new modality for preoperative localization of parathyroid adenomas. We performed a survey study to describe the role and trends in the utilization of 4D-CT. Of 361 radiologists, 200 (55%) reported that 4D-CT was used in their practices. Nineteen (10%) used 4D-CT as the first-line imaging study; 155 (76%) reported that 4D-CT played a secondary role; and 26 (13%) reported that it is performed routinely in combination with ultrasound and scintigraphy. Early adopters of 4D-CT (use for >3 years) were 3 times more likely to use 4D-CT in a first-line role (18%) when compared with radiologists who used 4D-CT for ≤3 years (6%; P < .05). In conclusion, more than half of radiologists perform 4D-CT, and a majority reported that 4D-CT plays a secondary role. However, this role may change, as utilization is increasing and radiologists may follow early adopters, who are more likely to use it as a first-line study.
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Affiliation(s)
- Jenny K Hoang
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA .,Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Katherine Williams
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Frank Gaillard
- Department of Radiology, Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Andrew Dixon
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - Julie A Sosa
- Section of Endocrine Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Azizi G, Piper K, Keller JM, Mayo ML, Puett D, Earp KM, Malchoff CD. Shear wave elastography and parathyroid adenoma: A new tool for diagnosing parathyroid adenomas. Eur J Radiol 2016; 85:1586-93. [PMID: 27501893 DOI: 10.1016/j.ejrad.2016.06.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/26/2016] [Accepted: 06/15/2016] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study prospectively determines the shear wave elastography characteristics of parathyroid adenomas using virtual touch imaging quantification, a non-invasive ultrasound based shear wave elastography method. METHODS This prospective study examined 57 consecutive patients with biochemically proven primary hyperparathyroidism and solitary parathyroid adenoma identified by ultrasound and confirmed by at least one of the following: surgical resection, positive Technetium-99m Sestamibi Scintigraphy (MIBI) scan, or fine needle aspiration biopsy with positive PTH washout (performed only in MIBI negative patients). Vascularity and shear wave elastography were performed for all patients. Parathyroid adenoma stiffness was measured as shear wave velocity in meters per second. RESULTS The median (range) pre-surgical value for PTH and calcium were 58pg/mL (19, 427) and 10.8mg/dL (9.5, 12.1), respectively. 37 patients had positive MIBI scan. 20 patients had negative MIBI scan but diagnosis was confirmed with positive PTH washout. 42 patients underwent parathyroidectomy, and an adenoma was confirmed in all. The median (range) shear wave velocity for all parathyroid adenomas enrolled in this study was 2.02m/s (1.53, 2.50). The median (range) shear wave velocity for thyroid tissue was 2.77m/s (1.89, 3.70). The shear wave velocity of the adenomas was independent of adenoma size, serum parathyroid hormone concentration, or plasma parathyroid hormone concentration. CONCLUSIONS Tissue elasticity of parathyroid adenoma is significantly lower than thyroid tissue. B-mode features and distinct vascularity pattern are helpful tools in diagnosing parathyroid adenoma with ultrasound. Shear wave elastography may provide valuable information in diagnosing parathyroid adenoma.
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Affiliation(s)
- Ghobad Azizi
- Wilmington Endocrinology, 1717 Shipyard Boulevard, Wilmington, NC 28403, United States.
| | - Kelé Piper
- Beth Israel Deaconess Medical Center 109 Brookline Avenue, Suite 200, Boston, MA 02215, United States.
| | - James M Keller
- Wilmington Pathology Associates 1915 South 17th Street, Suite 100 Wilmington, NC 28401, United States.
| | - Michelle L Mayo
- Wilmington Endocrinology, 1717 Shipyard Boulevard, Wilmington, NC 28403, United States
| | - David Puett
- Carolina Arthritis 1710 South 17th Street, Wilmington, NC 28401, United States.
| | - Karly M Earp
- Wilmington Endocrinology, 1717 Shipyard Boulevard, Wilmington, NC 28403, United States
| | - Carl D Malchoff
- University of Connecticut Health Center263 Farmington Avenue, Farmington, CT 06030, United States.
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Lee YH, Seo HS, Suh SI, Ryoo I, You SH, Son KR, Kwon SY, Son GS, Yang KS. Feasibility Study of a Contrast-Enhanced Multi-Detector CT (64 Channels) Protocol for Papillary Thyroid Carcinoma: The Influence of Different Scan Delays on Tumor Conspicuity. Thyroid 2016; 26:726-33. [PMID: 26959312 DOI: 10.1089/thy.2015.0415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Recently, a number of studies have advocated the diagnostic benefit of contrast-enhanced computed tomography (CECT) in the current ultrasound (US)-based preoperative evaluation of thyroid cancer. However, no study has been conducted to optimize a CECT protocol focusing on tumor conspicuity using a multi-detector CT scanner. This study aimed at determining the optimal scan delay for increased CT attenuation differences between thyroid cancer and parenchymal background using a biphasic CECT examination. METHODS This study retrospectively enrolled 84 patients (M:F = 7:77; Mage = 44.8 ± 10.9 years) with 87 papillary thyroid carcinomas (Msize = 14.1 mm) who consecutively underwent US and CECT examination prior to surgery. In each patient, CT scanning was taken twice-once with a 40-second delay and once with a 70-second delay-using a 64-channel multi-detector scanner. After obtaining the mean attenuation value (MAV) of the thyroid cancer and the ipsilateral parenchyma by drawing regions of interest on the CECT images based on their cytopathologic results and US findings, the parenchyma-cancer differences (PCD) between the early and delayed scans were simply compared using a paired t-test. Then, the mean differences in the MAVs of the thyroid cancer and ipsilateral parenchyma (hereafter abbreviated as Group) between the early and delayed scans (abbreviated as Time) were compared after adjusting for the other factors that significantly affected MAVs, such as concentration of iodinated contrast medium (abbreviated as CCM) and size of thyroid cancer (abbreviated as Size) using a repeated-measures general linear model. RESULTS Because the ipsilateral parenchyma exhibited significantly higher attenuation on the early scan and further decline on the delayed scan compared with thyroid cancer (p < 0.001), the PCD for thyroid cancer was significantly better with a 40-second scan delay than a 70-second delay (58.8 ± 36.6 Hounsfield units [HU] vs. 40.4 ± 25.6 HU; p < 0.001). Similar results were obtained from the repeated-measures general linear model that considered the effects of CCM, Size, Group, and Time, and the interaction of Group and Time. CONCLUSION Based on this CECT study that adjusted for the effects of CCM and size on MAV, early scans (e.g., 40-second scan delay) are helpful for improving the tumor conspicuity of thyroid cancer on CECT images.
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Affiliation(s)
- Young Hen Lee
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Hyung Suk Seo
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Sang-Il Suh
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Inseon Ryoo
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Sung-Hye You
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Kyu Ri Son
- 1 Department of Radiology, Korea University College of Medicine , Seoul, Republic of Korea
| | - Soon-Young Kwon
- 2 Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine , Seoul, Republic of Korea
| | - Gil Soo Son
- 3 Department of Surgery, Korea University College of Medicine , Seoul, Republic of Korea
| | - Kyung-Sook Yang
- 4 Department of Biostatistics, Korea University College of Medicine , Seoul, Republic of Korea
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