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Warshavsky A, Rubin R, Carmel-Neidermann NN, Brenner A, Shendler G, Kampel L, Izkhakov E, Muhanna N, Horowitz G. 4DCT in Discordant Parathyroid Adenoma Scans: Case Series and Meta-Analysis. Laryngoscope 2024; 134:2198-2205. [PMID: 37929814 DOI: 10.1002/lary.31142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To evaluate the accuracy of four-dimensional computerized-tomography (4DCT) for localizing parathyroid adenomas (PTAs) in cases with discordant or non-localizing ultrasonography (US) and Technetium-99 sestamibi (MIBI) scans. DATA SOURCES Retrospective case series and systematic review. REVIEW METHODS A case series and meta-analysis of patients diagnosed with primary hyperparathyroidism and discordant US and MIBI scans who underwent 4DCT prior to surgery. A comprehensive search for all relevant publications in the English literature between December 2006 and March 2022 was conducted for the meta-analysis. Patients undergoing parathyroidectomy between January 2015 and December 2021 were identified from the institutional electronic database for the case series. All studies were analyzed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the 4DCT adenoma localization capabilities. RESULTS Thirteen retrospective studies that included 379 patients and one case series that included 37 patients were identified and analyzed. A per-patient analysis revealed sensitivity for lateralization to the correct side (n = 181) ranging from 80% to 100% with a fixed effects model of 89% (95%confidence interval [CI]: 82%-93%) and a PPV for lateralization ranging from 63%-95% with a random effects model of 87% (95% CI: 77%-95%). Sensitivity of localization to the correct quadrant (n = 172) ranged from 53% to 100% with a random effects model of 90.4% (95% CI: 76%-99%), and the PPV for localization ranged from 52% to 100% with a random effects model of 82% (95% CI: 73%-89%). CONCLUSION 4DCT enhances imaging capabilities of localizing PTAs in cases of discordant or non-localizing US and MIBI scans. LEVEL OF EVIDENCE NA Laryngoscope, 134:2198-2205, 2024.
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Affiliation(s)
- Anton Warshavsky
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Raz Rubin
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Narin Nard Carmel-Neidermann
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Adi Brenner
- Radiology and Imaging, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Genady Shendler
- Radiology and Imaging, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Liyona Kampel
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Elena Izkhakov
- The Institute of Endocrinology, School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery and The Department of Radiology and Imaging, Metabolism and Hypertension, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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Sayed S, Das A, Turner B, Wadhwa VS, Pathak KA. Role of four-dimensional computer tomography (4D-CT) in non-localising and discordant first-line imaging in primary hyperparathyroidism. Ann R Coll Surg Engl 2023; 105:739-746. [PMID: 36748800 PMCID: PMC10618046 DOI: 10.1308/rcsann.2022.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Accurate preoperative localisation of parathyroid adenoma is imperative for the success of minimally invasive parathyroidectomy (MIP). OBJECTIVE Our study aimed to evaluate the role of four-dimensional computer tomography (4D-CT) scan as an imaging modality in patients with failed and discordant localisation reported in the first-line imaging modalities (ultrasonography and 99mTc-MIBI-SPECT/CT). METHODS This is a prospective cohort study performed at a university teaching centre from March 2013 to July 2021. All patients with primary hyperparathyroidism who had failed localisation by ultrasonography and 99mTc-MIBI-SPECT/CT (SpCT), or discordance between them, had 4D-CT performed in this study. RESULTS One hundred and two sporadic cases of pHPT with failed/discordant first-line imaging had 4D-CT imaging prior to parathyroidectomy. In 102 patients, 105 parathyroid adenomas were reported on histopathology. 4D-CT was able to localise 78% of them to the correct side and 64% to the correct quadrant in 102 patients, as compared with US (correct side 21%, correct quadrant 16%) and 99mTc-MIBI-SPECT/CT (correct side 36%, correct quadrant 31%). 4D-CT had a sensitivity, precision, accuracy and F1 score for correct quadrant localisation as 79%, 81%, 66% and 80%; and for correct side localisation as 82%, 98%, 80% and 89%, respectively. 4D-CT was able to identify three ectopic adenomas (two in superior mediastinum and one in the oesophageal wall) which were not detected on US or SpCT. CONCLUSION 4D-CT was found to be sensitive and accurate in preoperative localising of the diseased parathyroid glands after failed/discordant US and SpCT. This led to more patients being offered MIP as the primary surgery and improved operative outcomes.
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Affiliation(s)
- S Sayed
- CancerCare Manitoba, Winnipeg, Canada
| | - A Das
- Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India
| | - B Turner
- CancerCare Manitoba, Winnipeg, Canada
| | - V S Wadhwa
- Cedars Sinai Medical Center, Los Angeles, USA
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Sharma A, Patil V, Sarathi V, Purandare N, Hira P, Memon S, Jadhav SS, Karlekar M, Lila AR, Bandgar T. Dual-phase computed tomography for localization of parathyroid lesions in children and adolescents with primary hyperparathyroidism. ANNALES D'ENDOCRINOLOGIE 2023:S0003-4266(23)00035-5. [PMID: 36906257 DOI: 10.1016/j.ando.2023.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Childhood and adolescent primary hyperparathyroidism (PHPT) is a rare disease caused by single adenomas in 65-94% of patients. In this patient group, there is no data on computed tomography (CT) for pre-operative parathyroid localization that may facilitate focused parathyroidectomy. METHODS Two radiologists reviewed dual-phase (nonenhanced and arterial) CT images of twenty-three operated children and adolescents [20:single-gland disease(SGD), 3:multi-glandular disease(MGD)] with proven histopathological PHPT. Percentage arterial enhancement (PAE) was calculated as [100*{arterial-phase Hounsfield unit (HU)-nonenhanced phase HU}/nonenhanced HU] of the parathyroid lesion(s), thyroid, and lymph node. RESULTS Dual-phase CT lateralized 100%, localized to the correct quadrant/site 85% SGD (including 3/3 ectopic), and identified 1/3 MGD. PAE (cutoff ≥ 112.3%) was sensitive (91.3%) and specific (99.5%) in distinguishing parathyroid lesions from local mimics (P<0.001). The average effective dose was 3.16±1.01mSv, comparable to the planar/single photon emission CT (SPECT) Technetium 99m(Tc)-sestamibi and choline positron emission tomography (PET)/CT scans. Solid-cystic morphology identified in 4 patients harboring pathogenic germline variants (3:CDC73, 1:CASR) may serve as a radiological clue to molecular diagnosis. Nineteen out of 20 (95%) patients with SGD who had undergone single gland resection based on pre-operative CT findings were in remission over a median follow-up of 18 months. CONCLUSION As most children/adolescents with PHPT have SGD, dual-phase CT protocols which reduce the effective radiation dose with high localization sensitivity for single parathyroid lesions may be a sustainable pre-operative imaging modality in this patient group.
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Affiliation(s)
- Anima Sharma
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India
| | - Virendra Patil
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India
| | - Vijaya Sarathi
- Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India
| | - Nilendu Purandare
- Department of Nuclear Medicine & Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Parel, Mumbai, India
| | - Priya Hira
- Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Parel, Mumbai, India
| | - Saba Memon
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India
| | - Swati S Jadhav
- Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, India
| | - Manjiri Karlekar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India
| | - Anurag R Lila
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India.
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Daoud A, Ronen O. Parathyroid Cystic Adenoma: A Systematic Review and Meta-Analysis. Endocr Pract 2023; 29:2-10. [PMID: 36370985 DOI: 10.1016/j.eprac.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review diagnostic imaging modalities for parathyroid cystic adenomas (PCA). Since PCAs are a rare (0.5%-1%) subclass of parathyroid adenomas, and due to their cystic component, imaging modalities known to be efficient for diagnosing solid adenomas might fail in localizing them. METHODS We conducted a systematic review using the PubMed and Cochrane databases for English articles on PCAs published between 1995 and 2020. A meta-analysis of the retrieved data was performed. RESULTS Overall, 39 studies, reporting on a total of 160 patients, were included in the analysis. Two thirds (68%) of the patients were female, with a mean age of 53.9 years. A single cystic adenoma was detected in 98.1% of cases. The mean blood calcium corrected for albumin level was 12.6 ± 2.7 mg/dL, and the mean parathyroid hormone level was 565.5 ± 523.8 pg/mL. The mean PCA sizes as measured by ultrasound (US), computed tomography (CT), and ex vivo measurement were 4.8 ± 3.6, 5.2 ± 3.2, and 3.5 cm, respectively. The median weight was 8.1 g. PCA was detected in 86% of US examinations; 100% of US-guided fine needle aspiration, 4-dimensional computed tomography (4D-CT), or magnetic resonance imaging examinations; and 61% of 99m-technetium sestamibi scan with single-photon emission computed tomography ((99m)Tc-SPECT). (99m)Tc-SPECT showed a significantly lower diagnostic rate than US (odds ratio, 3.589), US-guided fine needle aspiration, CT combined with 4D-CT, and the combination of US, CT, 4D-CT, and magnetic resonance imaging (P < .001). CONCLUSION Although US and 4D-CT showed a significantly high rate in diagnosing PCA, (99m)Tc-SPECT showed a lower PCA diagnostic rate. These findings suggest that larger cystic lesions suspected as PCAs should be further evaluated using 4D-CT rather than (99m)Tc-SPECT.
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Affiliation(s)
- Amani Daoud
- Department of Otolaryngology, Head and Neck Surgery Unit, Galilee Medical Center, Nahariya, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery Unit, Galilee Medical Center, Nahariya, affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
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Debnam JM, Chi TL, Kwon M, Sun J, Schellingerhout D, Golant BT, Ahmed S, Perrier ND, Vu T. Distinguishing Intrathyroid Parathyroid Adenoma from Colloid Nodules and Papillary Thyroid Carcinomas Using Multiphasic Multidetector Computed Tomography. J Comput Assist Tomogr 2022; 46:808-814. [PMID: 36103680 PMCID: PMC9494761 DOI: 10.1097/rct.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study is to determine whether multiphase multidetector computed tomography (4D-MDCT) can differentiate between intrathyroid parathyroid adenomas (ITPAs), colloid nodules, and papillary thyroid carcinoma (PTC). METHODS We studied 22 ITPAs, 22 colloid nodules, and 11 PTCs in 55 patients. Hounsfield unit (HU) values of the nodules were measured on 4D-MDCT in the precontrast, arterial, venous, and delayed phases. Raw HU values, phase with peak enhancement, and washout percentages between the phases were evaluated. RESULTS Regardless of size, all ITPAs (22/22) showed peak enhancement in the arterial phase, which was significantly greater than both colloid nodules (15/22) and PTC (6/11, P = 0.002); thus, nodules with peak enhancement in the venous or delayed phase were not ITPAs (specificity = 1). For nodules with peak enhancement in the arterial phase, the percentage washout in the arterial-to-venous phases separated ITPAs from PTC and colloid nodules (P < 0.001) with greater than or equal to 23.95% loss of HU value implying IPTA (area under curve, 0.79). This left a subset of colloid nodules or PTC that either peaked in the venous or delayed phase or had an arterial-to-venous phase washout of less than 23.95%. From this subset, PTC measuring 1 cm or greater could be separated from colloid based on HU values in the arterial phase with a cutoff HU value less than 81.4 for PTC (area under curve, 0.72) and an HU value greater than 164.5 suggested colloid. CONCLUSIONS Intrathyroid parathyroid adenomas can be distinguished from colloid nodules and PTC by peak enhancement in the arterial phase and rapid washout. A subset of colloid and PTC measuring 1 cm or greater can be separated using arterial phase HU values.
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Affiliation(s)
- J. Matthew Debnam
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - T. Linda Chi
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Kwon
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dawid Schellingerhout
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Brandon T. Golant
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Salmaan Ahmed
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy D. Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thinh Vu
- Department of Neuroradiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bunch PM, Nguyen CJ, Johansson ED, Randle RW. Opportunistic Parathyroid Gland Assessment on Routine CT Could Decrease Morbidity from Undiagnosed Primary Hyperparathyroidism. Acad Radiol 2022; 30:881-890. [PMID: 35760712 DOI: 10.1016/j.acra.2022.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES Gaps in primary hyperparathyroidism diagnosis are well-documented. End-organ damage correlates with disease duration and often occurs before diagnosis. We hypothesize that opportunistic parathyroid gland assessment on routine CT could decrease existing diagnosis gaps. Our purpose is to assess for enlarged parathyroid glands on contrast-enhanced CT acquired prior to biochemical screening and subsequent development of related morbidity. MATERIALS AND METHODS This retrospective study included consecutive patients with primary hyperparathyroidism undergoing parathyroidectomy with contrast-enhanced CT including the lower neck and upper chest acquired prior to biochemical screening. One neuroradiologist retrospectively evaluated all CTs for enlarged (estimated weight greater than 60 mg) parathyroid glands. Gold standard operative and pathology reports were correlated with CT findings, and medical records were reviewed for development of primary hyperparathyroidism-related comorbidities. RESULTS The sample comprised 38 patients (30 women, 8 men, median age 60 years) with 70 CTs of interest. The neuroradiologist identified 32 putative enlarged parathyroid glands (median estimated weight 307 mg) in 29 (76%) patients on CTs predating biochemical screening by a median of 30 months. Putative enlarged parathyroid glands on CT corresponded to pathologically proven parathyroid lesions in 26 (90%) patients. Of 26 patients with retrospectively identified pathologically proven parathyroid lesions, 12 (46%) developed at least 1 renal, bone, or neurocognitive comorbidity between CT and subsequent biochemical screening. CONCLUSION Enlarged parathyroid glands are frequently visible on routine CTs acquired years prior to primary hyperparathyroidism diagnosis. Biochemical screening based on enlarged glands could potentially prevent associated morbidity in almost half of such patients.
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Sonawane S, Jadhav SS, Goroshi M, Krishnappa B, Sharma A, Hira P, Garle MN, Gosavi V, Memon S, Patil VA, Lila AR, Shah N, Bandgar T. Percentage arterial enhancement on 2D CT in the diagnosis of primary hyperparathyroidism: A prospective validation study and potential pitfalls. Head Neck 2022; 44:1849-1856. [PMID: 35638259 DOI: 10.1002/hed.27108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 04/10/2022] [Accepted: 05/11/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Parathyroid lesions are identified by subjective enhancement and washout patterns on computed tomography (CT). We have previously proposed "percentage arterial enhancement" (PAE) as an objective index and now aim to validate its performance prospectively. METHODS Dual-phase CT was performed in 40 consecutive primary hyperparathyroidism patients. PAE was calculated as [{arterial phase Hounsfield unit (HU)-unenhanced phase HU}/unenhanced phase HU] × 100. PAE > 128.9% was considered parathyroid. RESULTS PAE had 94.2% sensitivity, 100% positive predictive value (PPV) in lateralization, and sensitivity and PPV of 93.9% in quadrant localization of single-gland disease. PAE failed to identify two lesions: an intrathyroidal parathyroid carcinoma in the background of multinodular goiter and another lower enhancing cystic parathyroid adenoma. PAE had 60% sensitivity, and 100% PPV to identify multigland disease. The mean effective dose was 2.74 mSV. CONCLUSIONS PAE is a specific CT index for parathyroid lesions with less radiation exposure. Areas of caution include intrathyroidal and cystic lesions.
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Affiliation(s)
- Sushil Sonawane
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Swati S Jadhav
- Department of Endocrinology, Sapthagiri Institute of Medical Sciences and Research Centre, Bangalore, India
| | - Manjunath Goroshi
- Department of Endocrinology, Jawaharlal Nehru Medical College, Belagavi, India
| | - Brijesh Krishnappa
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Anima Sharma
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Priya Hira
- Department of Radiodiagnosis, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Mahadev N Garle
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Vikrant Gosavi
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Saba Memon
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Virendra A Patil
- 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
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College and KEM Hospital, Mumbai, India
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Kumar M, Chauhan VS, Khandare M, Kumar Yadav S. Severe Symptomatic Primary Hyperparathyroidism with Normocalcemia: a Case Report. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03420-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Zarei A, Karthik S, Chowdhury F, Patel C, Scarsbrook A, Vaidyanathan S. Multimodality imaging in primary hyperparathyroidism. Clin Radiol 2022; 77:e401-e416. [DOI: 10.1016/j.crad.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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Parathyroid 4D-CT in Primary Hyperparathyroidism: Exploration of Size Measurements for Identifying Multigland Disease and Guiding Biochemically Successful Parathyroidectomy. AJR Am J Roentgenol 2021; 218:888-897. [PMID: 34935402 DOI: 10.2214/ajr.21.26935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background: In patients with primary hyperparathyroidism (PHPT), bilateral neck exploration is necessary for multigland disease (MGD), whereas minimally-invasive parathyroidectomy is often preferred for single-gland disease (SGD). An existing system (4D-CT MGD score) for differentiating SGD and MGD using preoperative parathyroid CT considers the size of only the largest candidate lesion. Objective: To assess utility of second-largest lesion size on parathyroid CT for differentiating SGD from MGD, as well as of individual gland size for predicting need for surgical removal, and to derive optimal size thresholds for these purposes. Methods: This retrospective study included patients with PHPT who underwent biochemically successful parathyroidectomy after preoperative parathyroid CT. Clinical radiology reports were reviewed to classify reported candidate parathyroid lesions as low-, intermediate- or high-confidence. Resected hypercellular parathyroid lesions were correlated with clinically reported candidate lesions. Patients were classified as having SGD or MGD using operative and pathology reports, independent of CT findings. One observer retrospectively determined estimated volume (0.52 x length x width x height) and maximum diameter of clinically reported high-confidence lesions, as well as examinations' 4D-CT MGD scores. Diagnostic performance was assessed. Results: The sample comprised 62 patients (41 women, 21 men; median age 65 years; 47 with SGD, 15 with MGD), with 151 candidate lesions, including 106 high-confidence lesions. Based on second-largest high-confidence lesions, estimated volume at 60-mm3 threshold achieved 53% sensitivity and 96% specificity, while maximum diameter at 7-mm threshold achieved 67% sensitivity and 96% specificity; 4D-CT MGD score ≥3 achieved 47% sensitivity and 68% specificity. For predicting need to remove a gland for successful parathyroidectomy, estimated volume at 114-mm3 threshold achieved 84% sensitivity and 97% specificity, and at 55-mm3 threshold achieved 93% sensitivity and 87% specificity; maximal diameter at 7-mm threshold achieved 93% sensitivity and 84% specificity. Conclusion: Estimated volume and maximum diameter of high-confidence candidate lesions can differentiate SGD from MGD and identify individual glands requiring removal for successful parathyroidectomy. Differentiating SGD and MGD may be aided by considering both first- and second-largest high-confidence lesions. Clinical Impact: The findings will help identify patients likely to require bilateral neck explorations, informing preoperative patient counseling and individualized operative planning.
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Jain A, Yadav N, Silodia A, Khandelwal N, Yadav SK. Primary hyperparathyroidism misdiagnosed as metastatic disease, with trans-oral endoscopic surgical management. Trop Doct 2021; 52:182-184. [PMID: 34348509 DOI: 10.1177/00494755211035223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary hyperparathyroidism is not so uncommon a disease. In high-income countries, with the introduction of routine biochemical testing in 1980s, it is diagnosed early, and the majority are seen as asymptomatic disease. However, in India, a severe symptomatic form is still seen, and many times patients are undiagnosed, thus continuing to suffer debilitating disease. Here, we report such a patient who was being treated as having bony metastases from an unknown primary source, when in fact he had osteitis fibrosa cystica due to primary hyperparathyroidism and was cured after surgery.
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Affiliation(s)
- Ankur Jain
- Surgery Resident, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Nishtha Yadav
- Assistant Professor, Department of Neuroradiology, Super Specialty Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ashutosh Silodia
- Professor, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Namrata Khandelwal
- Assistant Professor, Department of Neurology, Super Specialty Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Sanjay Kumar Yadav
- Assistant Professor, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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4DCT Scanning Technique for Primary Hyperparathyroidism: A Scoping Review. Radiol Res Pract 2021; 2021:6614406. [PMID: 34094599 PMCID: PMC8163538 DOI: 10.1155/2021/6614406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 04/11/2021] [Accepted: 05/13/2021] [Indexed: 12/27/2022] Open
Abstract
Objective 4DCT for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. Protocols are often institution-specific; this review aims to summarize the different protocols and explore the reported sensitivity and specificity of different 4DCT protocols as well as the associated dose. Materials and Methods A literature study was independently conducted by two radiologists from April 2020 until May 2020 using the Medical Literature Analysis and Retrieval System Online (MEDLINE) database. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize different parameters of the scanning protocol and observed diagnostic attributes. Results A total of 51 articles were included and 56 scanning protocols were identified. Most protocols use three (n = 25) or four different phases (n = 23). Almost all authors include noncontrast enhanced imaging and an arterial phase. Arterial images are usually obtained 25–30 s after administration of contrast, and less agreement exists concerning the timing of the venous phase(s). A mean contrast bolus of 100 mL is administered at 3-4 mL/s. Bolus tracking is not often used (n = 3). A wide range of effective doses are reported, up to 28 mSv. A mean sensitivity of 81.5% and a mean specificity of 86% are reported. Conclusion Many different 4DCT scanning protocols for the detection of parathyroid adenomas exist in the literature. The number of phases does not appear to affect sensitivity or specificity. A triphasic approach, however, seems preferable, as three patterns of enhancement of parathyroid adenomas are described. Bolus tracking could help to reduce the variability of enhancement. Sensitivity and specificity also do not appear to be affected by other scan parameters like tube voltage or tube current. To keep the effective dose within limits, scanning at a lower fixed tube current seems preferable. Lowering tube voltage from 120 kV to 100 kV may yield similar image contrast but would also help lower the dose.
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Leong D, Ng K, Boeddinghaus R, Lisewski D. Three-phase four-dimensional computed tomography as a first-line investigation in primary hyperparathyroidism. ANZ J Surg 2021; 91:1798-1803. [PMID: 33982332 DOI: 10.1111/ans.16924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/25/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Parathyroid computed tomography using multiple phases (four-dimensional computed tomography (4DCT) for parathyroid localization was first described in 2006. Since its inception, there has been variable uptake of this technique due to inconsistency of results between institutions and perceived higher radiation dose than technetium-99 sestamibi scans (MIBI). 4DCT has been the primary imaging modality for parathyroid localization at our institution since 2013. METHODS A retrospective study of surgically managed patients with primary hyperparathyroidism who had preoperative localization with 4DCT from 2013-2018 was performed. RESULTS A total of 353 patients were included for analysis. The positive predictive value (PPV) of our three-phase 4DCT protocol was 93.3%, sensitivity (localized) 85.2% with a 5.8% false-positive rate and 13.9% false-negative (non-localizing) rate when reported by a head and neck radiologist (HNR). Calculated effective dose varied from 4.5 to 8.9mSV. On multivariable logistic regression, reporting by an experienced HNR (P < 0.001) and gland weight > 200 mg (P = 0.002) were significant for higher accuracy, lower false positives and false negatives. CONCLUSION A first-line three-phase 4DCT protocol for primary hyperparathyroidism is an accurate technique providing precise anatomical localization of abnormal parathyroid glands, particularly when performed by a specialist HNR. In our practise, it provides the best rate of detection and superior anatomical localization needed for minimally invasive parathyroid surgery, compared to other commonly used localization techniques. It also avoids the need for four gland exploration in the majority of patients with primary hyperparathyroidism.
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Affiliation(s)
- David Leong
- Endocrine Surgical Services, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Katrina Ng
- Endocrine Surgical Services, Sir Charles Gairdner Hospital, Western Australia, Australia
| | - Rudolf Boeddinghaus
- Department of Surgery, University of Western Australia, Nedlands, Western Australia, Australia.,Perth Radiological Clinic, Subiaco, Western Australia, Australia
| | - Dean Lisewski
- Department of Endocrine Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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14
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Detection of parathyroid adenomas with multiphase 4DCT: towards a true four-dimensional technique. BMC Med Imaging 2021; 21:64. [PMID: 33827463 PMCID: PMC8028189 DOI: 10.1186/s12880-021-00597-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Background Four-dimensional computed tomography (4DCT) is a commonly performed examination in the management of primary hyperparathyroidism, combining three-dimensional imaging with enhancement over time as the fourth dimension. We propose a novel technique consisting of 16 different contrast phases instead of three or four different phases. The main aim of this study was to ascertain whether this protocol allows the detection of parathyroid adenomas within dose limits. Our secondary aim was to examine the enhancement of parathyroid lesions over time. Methods For this prospective study, we included 15 patients with primary hyperparathyroidism and a positive ultrasound prior to surgery. We performed 4DCT with 16 different phases: an unenhanced phase followed by 11 consecutive arterial phases and 4 venous phases. Continuous axial scanning centered on the thyroid was performed over a fixed 8 cm or 16 cm coverage volume after the start of contrast administration. Results In all patients, an enlarged parathyroid lesion was demonstrated, and the mean lesion size was 13.6 mm. The mean peak arterial enhancement for parathyroid lesions was 384 Hounsfield units (HU) compared to 333 HU for the normal thyroid. No significant difference could be found. The time to peak (TTP) was significantly earlier for parathyroid adenomas than for normal thyroid tissue: 30.8 s versus 32.3 s (p value 0.008). The mean slope of increase (MSI) of the enhancement curve was significantly steeper than that of normal thyroid tissue: 29.8% versus 22.2% (p value 0.012). The mean dose length product was 890.7 mGy cm with a calculated effective dose of 6.7 mSv. Conclusion Our 4DCT protocol may allow better visualization of the pattern of enhancement of parathyroid lesions, as enhancement over time curves can be drawn. In this way, wash-in and wash-out of contrast in suspected lesions can be readily demonstrated. Motion artifacts are less problematic as multiple phases are available. Exposure to our proposed 4DCT technique is comparable to that for classic helical 4DCT. Careful selection of parameters (lowering kV and SNR) can help to further reduce the dose.
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Ignat M, Pérouse M, Lefebvre F, Kadoche D, Imperiale A, Swanstrom L, Vix M, Mutter D. Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration. Surg Innov 2021; 28:261-271. [PMID: 33745354 DOI: 10.1177/15533506211001236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy-particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85-63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99-64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21-93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19-290.56%, P < 2.2 × 10-16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05-61.42%, P = 3.1 × 10-15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan (P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy (P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.
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Affiliation(s)
- Mihaela Ignat
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Madeleine Pérouse
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France
| | - François Lefebvre
- Department of Medical Informatics, 27083University Hospital of Strasbourg, Strasbourg, France
| | - Deborah Kadoche
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Alessio Imperiale
- 27083Médecine Nucléaire et Imagerie Moléculaire, ICANS, Strasbourg, France.,Imagerie Moléculaire, DRHIM, Institut Pluridisciplinaire Hubert Curien (IPHC), UMR, CNRS / Unistra, Strasbourg, France
| | - Lee Swanstrom
- 54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Michel Vix
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
| | - Didier Mutter
- Department of Digestive and Endocrine Surgery, University Hospital of Strasbourg, Strasbourg, France.,54809IHU/IRCAD, Institute of Image-guided Surgery, Strasbourg, France
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Murugan N, Kandasamy D, Sharma R, Goyal A, Gupta AK, Tandon N, Gupta N, Goswami R, Vurthaluru S, Damle N, Agrawal S. Comparison of 4DMRI and 4DCT for the preoperative evaluation of patients with primary hyperparathyroidism. Eur J Radiol 2021; 138:109625. [PMID: 33714845 DOI: 10.1016/j.ejrad.2021.109625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/23/2021] [Accepted: 03/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Minimally invasive parathyroid surgery is the standard of care in patients with Primary Hyperparathyroidism (PHPT) which requires accurate preoperative localization. Of all the available imaging modalities, 4DCT is considered the best modality for localization, however it entails the risk of ionizing radiation. To circumvent this 4DMRI was evaluated for parathyroid lesion localization. PURPOSE To evaluate and compare the accuracy of 4DCT and 4DMRI in the localization of parathyroid Lesions. MATERIALS AND METHODS In this ethically approved observational diagnostic study, 135 patients (age range: 10-75 years, male: female ratio - 1:2.1) with clinically and biochemically suspected PHPT were recruited. Of these, 56 patients underwent both 4DCT and 4DMRI. Six patients with positive imaging who didn't undergo surgery were excluded. A total of 50 patients with 61 proven parathyroid lesions were included for analysis. 48 patients had surgical and histopathological findings for the confirmation of imaging findings. RESULTS Both 4DCT and 4DMRI correctly detected 59/61 lesions in 48 patients. There was one false positive and two true negatives. In addition, 2 (3.22 %) lesions which were not detected by 4DCT and 4DMRI were found on surgery. The sensitivity of both 4DCT and 4DMRI was 96.7 %; specificity was 66.6 % and accuracy was 95.2 %. CONCLUSION 4DMRI and 4DCT had similar accuracy for the detection of parathyroid lesions. However, 4DMRI has the advantage of lack of exposure to ionizing radiation, which can be beneficial in younger patients.
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Affiliation(s)
- Narasimman Murugan
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Devasenathipathy Kandasamy
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
| | - Raju Sharma
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ankur Goyal
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Arun Kumar Gupta
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nikhil Tandon
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nandita Gupta
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Ravinder Goswami
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Seenu Vurthaluru
- Department of Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
| | - Shipra Agrawal
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India
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Giovanella L, Bacigalupo L, Treglia G, Piccardo A. Will 18F-fluorocholine PET/CT replace other methods of preoperative parathyroid imaging? Endocrine 2021; 71:285-297. [PMID: 32892309 DOI: 10.1007/s12020-020-02487-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/28/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is a common endocrine disorder usually due to hyperfunctioning parathyroid glands (HPs). Surgical removal of the HPs is the main treatment for PHPT, making the correct detection and localization of HPs crucial to guiding targeted and minimally invasive surgical treatment in patients with PHPT. To date, different imaging methods have been used to detect and localize HPs, including radiology, nuclear medicine, and hybrid techniques. METHODS The present work discusses the role and value of different imaging methods in PHPT and, particularly, evaluates the potential role of 18F-fluorcholine PET/CT as a "one-stop-shop" method for preoperative parathyroid localization in patients with PHPT. DISCUSSION Cervical ultrasound (US) and parathyroid scintigraphy using 99mTc-MIBI are the most commonly employed methods in clinical practice. More recently, four-dimensional computed tomography (4D CT) and positron emission tomography (PET) with radiolabeled choline have emerged as useful alternatives in cases of negative or discordant findings from first-line imaging methods. CONCLUSIONS Due to the excellent diagnostic performance of radiolabeled choline PET/CT and the low radiation burden, this technique seems to be an ideal candidate to substitute current imaging procedures including US, MIBI scintigraphy, 4D CT and MRI and perform a fast and reliable "one-stop-shop" preoperative localization of HP in patients with PHPT, including challenging cases of postoperative persistent/recurrent disease.
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Affiliation(s)
- Luca Giovanella
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland.
| | - Lorenzo Bacigalupo
- Department of Diagnostic Imaging, Radiology and Nuclear Medicine, Ente Ospedaliero Galliera, Genova, Italy
| | - Giorgio Treglia
- Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Research and Innovation Service, Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Arnoldo Piccardo
- Department of Diagnostic Imaging, Radiology and Nuclear Medicine, Ente Ospedaliero Galliera, Genova, Italy
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18
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Naqvi SHS, Brooks KA, Knackstedt MI, Eguia AA, Low GM, Jacks AE, Asi KW, Patino MO, Friedman ER, Karni RJ. 4D-CT facilitates focused parathyroidectomy in patients with primary hyperparathyroidism by maintaining a high negative-predictive value for uninvolved quadrants. Am J Otolaryngol 2020; 41:102683. [PMID: 32862032 DOI: 10.1016/j.amjoto.2020.102683] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Improved preoperative localization facilitates minimally invasive parathyroidectomy for removal of parathyroid lesions therefore preventing an invasive bilateral neck exploration. As 4D-CT has emerged, its high specificity has helped with preoperative parathyroid lesion localization. A high negative predictive value (NPV) would serve to further confirm parathyroid lesion localization and limit unnecessary surgical exploration. This study's objective was to determine the NPV of preoperative 4D-CT and its facilitation of minimally invasive parathyroidectomy. METHODS A retrospective review was compiled for patients undergoing parathyroidectomy for primary hyperparathyroidism with a preoperative 4D-CT. Included patients were sorted into various groups for comparison: those with 4D-CT localizing to a single lesion, localizing to multiple lesions, and those with nonlocalizing findings; multiple hypercellular parathyroid gland versus single gland findings; extent of surgical exploration; lesion location; and patients with concomitant thyroid nodules. Negative predictive value was calculated and used to quantify the ability for 4D-CT to rule out biochemically significant parathyroid lesions. RESULTS In our review of 68 patients: sensitivity was 81.3%, specificity was 95.5%, positive predictive value was 87.1%, and negative predictive value was 93.3%. 86% had a single localizing 4D-CT, 7% had a non-localizing 4D-CT, and 7% had a multiple quadrant localizing 4D-CT. NPV for single and multi-localizing 4D-CT were 96.8% and 88.9%, respectively. CONCLUSION Preoperative 4D-CT has a high negative predictive value (93.3%), suggesting in the majority of cases, a quadrant with no 4D-CT radiographic findings suspicious for parathyroid is unlikely to harbor biochemically significant parathyroid lesions.
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Affiliation(s)
- Syed H S Naqvi
- Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America.
| | - Kaitlyn A Brooks
- Department of Otolaryngology - Head & Neck Surgery, Emory University School of Medicine, Atlanta, GA 30322, United States of America
| | - Mark I Knackstedt
- Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
| | - Arturo A Eguia
- Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
| | - Garren M Low
- Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
| | - Amy E Jacks
- Department of Otolaryngology - Head & Neck Surgery, University of Kansas School of Medicine, Kansas City, KS 66160, United States of America
| | - Karim W Asi
- Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
| | - Maria O Patino
- Division of Radiology, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
| | - Elliot R Friedman
- Division of Radiology, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
| | - Ron J Karni
- Department of Otorhinolaryngology - Head & Neck Surgery, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX 77030, United States of America
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19
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Uslu-Beşli L, Sonmezoglu K, Teksoz S, Akgun E, Karayel E, Pehlivanoglu H, Khosroshahi BR, Ocak M, Kabasakal L, Sager S, Bukey Y. Performance of F-18 Fluorocholine PET/CT for Detection of Hyperfunctioning Parathyroid Tissue in Patients with Elevated Parathyroid Hormone Levels and Negative or Discrepant Results in conventional Imaging. Korean J Radiol 2020; 21:236-247. [PMID: 31997599 PMCID: PMC6992441 DOI: 10.3348/kjr.2019.0268] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/22/2019] [Indexed: 02/07/2023] Open
Abstract
Objective Our aim was to assess the diagnostic performance of F-18 fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) in detecting hyperfunctioning parathyroid tissue (HPT) in patients with elevated parathyroid hormone levels with negative or inconclusive conventional imaging results and to compare the findings with those obtained using technetium-99m sestamibi (MIBI) scintigraphy and neck ultrasonography (US). Materials and Methods Images of 105 patients with hyperparathyroidism who underwent FCH PET/CT, dual-phase MIBI parathyroid scintigraphy (median interval: 42 days), and neck US were retrospectively analyzed. The gold standard was histopathological findings for 81 patients who underwent parathyroidectomy and clinical follow-up findings in the remaining 24 patients. Sensitivities, positive predictive values (PPVs), and accuracies were calculated for all imaging modalities. Results Among the 81 patients who underwent parathyroidectomy, either parathyroid adenoma (n = 64), hyperplasia (n = 9), neoplasia (n = 4), or both parathyroid adenoma and hyperplasia (n = 1) were detected, except 3 patients who did not show HPT. Of the 24 (23%) patients who were followed-up without operation, 22 (92%) showed persistent hyperparathyroidism. FCH PET/CT showed significantly higher sensitivity than MIBI scintigraphy and US in detection of HPT (p < 0.01). Sensitivity, PPV, and accuracy of FCH PET/CT were 94.1% (95/101), 97.9% (95/97), and 92.4% (97/105), respectively. The corresponding values for MIBI scintigraphy and US were 45.1% (46/102), 97.9% (46/47), and 45.7% (48/105) and 44.1% (45/102), 93.8% (45/48), and 42.9% (45/105), respectively. Among the 35 patients showing negative MIBI scintigraphy and neck US findings, 30 (86%) showed positive results on FCH PET/CT. FCH PET/CT could demonstrate ectopic locations of HPT in 11 patients whereas MIBI and US showed positive findings in only 6 and 3 patients, respectively. Conclusion FCH PET/CT is an effective imaging modality for detection of HPT with the highest sensitivity among the available imaging techniques. Therefore, FCH PET/CT can be recommended especially for patients who show negative or inconclusive results on conventional imaging.
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Affiliation(s)
- Lebriz Uslu-Beşli
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Kerim Sonmezoglu
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey.
| | - Serkan Teksoz
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Elife Akgun
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emre Karayel
- Department of Nuclear Medicine, Division of Radiopharmacy, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Huseyin Pehlivanoglu
- Department of Nuclear Medicine, Division of Radiopharmacy, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Baresh Razavi Khosroshahi
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Meltem Ocak
- Department of Pharmaceutical Technology, Istanbul University, Pharmacy Faculty, Istanbul, Turkey
| | - Levent Kabasakal
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Sait Sager
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Yusuf Bukey
- Department of General Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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20
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Debnam JM, Guha-Thakurta N, Sun J, Wei W, Zafereo ME, Cabanillas ME, Buisson NM, Schellingerhout D. Distinguishing Recurrent Thyroid Cancer from Residual Nonmalignant Thyroid Tissue Using Multiphasic Multidetector CT. AJNR Am J Neuroradiol 2020; 41:844-851. [PMID: 32327435 DOI: 10.3174/ajnr.a6519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE During thyroidectomy incomplete resection of the thyroid gland may occur. This complicates the imaging surveillance of these patients as residual thyroid needs to be distinguished from local recurrence. Therefore, the purpose of this study was to determine if multiphasic multi-detector computed tomography (4D-MDCT) can differentiate residual nonmalignant thyroid tissue and recurrent thyroid carcinoma after thyroidectomy. MATERIALS AND METHODS In this retrospective study, Hounsfield unit values on multiphasic multidetector CT in precontrast, arterial (25 seconds), venous (55 seconds), and delayed (85 seconds) phases were compared in 29 lesions of recurrent thyroid cancer, 29 with normal thyroid, and 29 with diseased thyroid (thyroiditis/multinodular thyroid). The comparison of Hounsfield unit values among lesion types by phase was performed using ANOVA. The performance of Hounsfield unit values to predict recurrence was evaluated by logistic regression and receiver operating characteristic analysis. RESULTS All 3 tissue types had near-parallel enhancement characteristics, with a wash-in-washout pattern. Statistically different Hounsfield unit density was noted between the recurrence (lowest Hounsfield unit), diseased (intermediate Hounsfield unit), and normal (highest Hounsfield unit) thyroid groups throughout all 4 phases (P < .001 for each group and in each phase). Dichotomized recurrence-versus-diseased/normal thyroid tissue with univariate logistic regression analysis demonstrated that the area under the receiver operating characteristic curve for differentiating benign from malignant thyroid for the various phases of enhancement was greatest in the precontrast phase at 0.983 (95% CI, 0.954-1), with a cutoff value of ≤62 (sensitivity/specificity, 0.966/0.983) followed by the arterial phase. CONCLUSIONS Recurrent thyroid carcinoma can be distinguished from residual nonmalignant thyroid tissue using multiphasic multidetector CT with high accuracy. The maximum information for discrimination is in the precontrast images, then the arterial phase. An optimal clinical protocol could be built from any number of phases but should include a precontrast phase.
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Affiliation(s)
- J M Debnam
- From the Departments of Diagnostic Radiology, Section of Neuroradiology (J.M.D., N.G.-T., N.M.B., D.S.)
| | - N Guha-Thakurta
- From the Departments of Diagnostic Radiology, Section of Neuroradiology (J.M.D., N.G.-T., N.M.B., D.S.)
| | - J Sun
- Biostatistics (J.S., W.W.)
| | - W Wei
- Biostatistics (J.S., W.W.)
| | - M E Zafereo
- Head and Neck Surgery, Division of Surgery (M.E.Z.)
| | | | - N M Buisson
- From the Departments of Diagnostic Radiology, Section of Neuroradiology (J.M.D., N.G.-T., N.M.B., D.S.)
| | - D Schellingerhout
- From the Departments of Diagnostic Radiology, Section of Neuroradiology (J.M.D., N.G.-T., N.M.B., D.S.)
- Cancer Systems Imaging (D.S.); The University of Texas MD Anderson Cancer Center, Houston, Texas
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Vijayasarathi A, Karnezis S, Azizyan A, Salamon N, Sepahdari A. 4D CT Parathyroid for the General Radiologist: A Pictorial Essay of Illustrative Cases. Curr Probl Diagn Radiol 2020; 51:659-665. [DOI: 10.1067/j.cpradiol.2020.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/06/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
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22
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Haleem A, Javaid M. Expected role of four-dimensional (4D) CT and four-dimensional (4D) MRI for the manufacturing of smart orthopaedics implants using 4D printing. J Clin Orthop Trauma 2019; 10:S234-S235. [PMID: 31700212 PMCID: PMC6823805 DOI: 10.1016/j.jcot.2019.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 12/30/2022] Open
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Practice Patterns in Parathyroid Surgery: A Survey of Asia-Pacific Parathyroid Surgeons. World J Surg 2019; 43:1964-1971. [PMID: 30941454 DOI: 10.1007/s00268-019-04990-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Practice variations exist amongst parathyroid surgeons depending on their expertise and resources. Our study aims to elucidate the choice of surgical techniques and adjuncts used in parathyroid surgery by surgeons in the Asia-Pacific region. METHODS A 25-question online survey was sent to members of five endocrine surgery associations. Questions covered training background, practice environment and preferred techniques in parathyroid surgery. Respondents were divided into three regions: Australia/New Zealand, South/South East Asia and East Asia, and responses were analysed according to region, specialty, case volume and years in practice. RESULTS One hundred ninety-six surgeons returned the questionnaire. Most surgeons (98%) routinely perform preoperative imaging, with 75% preferring dual imaging with 99mTcsestamibi and ultrasound. Ten per cent of surgeons use parathyroid 4DCT as first-line imaging, more commonly in East Asia (p = 0.038). Minimally invasive parathyroidectomy is the favoured technique of choice (97%). Most surgeons reporting robotic or endoscopic approaches are from East Asia. Rapid intraoperative parathyroid hormone is accessible to just under half of the surgeons but less available in Australian/New Zealand (p < 0.001). The use of intraoperative neuromonitoring is not commonly used, even less so amongst Asian surgeons (p = 0.048) and surgeons with low case load (p = 0.013). CONCLUSION Dual localisation techniques are the preferred choice of investigations in preparation for parathyroid surgery, with minimally invasive surgery without neuromonitoring the preferred approach. Use of adjuncts is sporadic and limited to certain centres.
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Zafereo M, Yu J, Angelos P, Brumund K, Chuang HH, Goldenberg D, Lango M, Perrier N, Randolph G, Shindo ML, Singer M, Smith R, Stack BC, Steward D, Terris DJ, Vu T, Yao M, Tufano RP. American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism. Head Neck 2019; 41:2398-2409. [PMID: 31002214 DOI: 10.1002/hed.25781] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/13/2022] Open
Abstract
Health care consumer organizations and insurance companies increasingly are scrutinizing value when considering reimbursement policies for medical interventions. Recently, members of several American Academy of Otolaryngology-Head & Neck Surgery (AAO-HNS) committees worked closely with one insurance company to refine reimbursement policies for preoperative localization imaging in patients undergoing surgery for primary hyperparathyroidism. This endeavor led to an AAO-HNS parathyroid imaging consensus statement (https://www.entnet.org/content/parathyroid-imaging). The American Head and Neck Society Endocrine Surgery Section gathered an expert panel of authors to delineate imaging options for preoperative evaluation of surgical candidates with primary hyperparathyroidism. We review herein the current literature for preoperative parathyroid localization imaging, with discussion of efficacy, cost, and overall value. We recommend that planar sestamibi imaging, single photon emission computed tomography (SPECT), SPECT/CT, CT neck/mediastinum with contrast, MRI, and four dimensional CT (4D-CT) may be used in conjunction with high-resolution neck ultrasound to preoperatively localize pathologic parathyroid glands. PubMed literature on parathyroid imaging was reviewed through February 1, 2019.
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Affiliation(s)
- Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Justin Yu
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Peter Angelos
- Section of Endocrine Surgery, Department of Surgery, University of Chicago, Chicago, Illinois
| | - Kevin Brumund
- Section of Head and Neck Surgery, UC San Diego Health System, San Diego, California
| | - Hubert H Chuang
- Department of Nuclear Medicine, MD Anderson Cancer Center, Houston, Texas
| | - David Goldenberg
- Otolaryngology - Head and Neck Surgery, Penn State College of Medicine, Hershey, Pennsylvania
| | - Miriam Lango
- Division of Head & Neck Surgery, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Nancy Perrier
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts
| | - Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health & Science University School of Medicine, Portland, Oregon
| | - Michael Singer
- Department of Otolaryngology - Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan
| | - Russell Smith
- Head and Neck Surgical Oncology, Baptist MD Anderson Cancer Center, Jacksonville, Florida
| | - Brendan C Stack
- Department of Otolaryngology - Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - David Steward
- Division of Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David J Terris
- Department of Otolaryngology, Medical College of Georgia, Augusta, Georgia
| | - Thinh Vu
- Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas
| | - Mike Yao
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York City, New York
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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Schwartz IE, Capra GG, Mullin DP, Johnson TE, Boswell GE. Parathyroid Computed Tomography Angiography: Early Experience with a Novel Imaging Technique in Primary Hyperparathyroidism. Otolaryngol Head Neck Surg 2019; 161:251-256. [DOI: 10.1177/0194599819842106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objectives To describe parathyroid computed tomography angiography (PCTA), determine its accuracy, and, as a secondary objective, calculate its mean radiation dosimetry. Study Design Retrospective chart review of patients who underwent parathyroidectomy for primary hyperparathyroidism from 2007 to 2015. Setting Single-center tertiary care academic military hospital. Subjects and Methods PCTA is a 2-phase computed tomography imaging technique that uses individualized timing of contrast infusion and novel patient positioning to accurately identify parathyroid adenomas. Consecutive patients who underwent parathyroidectomy for primary hyperparathyroidism from 2007 to 2015 were reviewed; 55% of patients were women. The mean age was 50.9 years (range, 26-68 years). Sensitivity and specificity were calculated as well as mean radiation dosimetry and timing of contrast. Results A total of 108 procedures were performed during the study period. Twenty-one patients undergoing 22 PCTAs after prior sestamibi scans were nonlocalizing or equivocal. In this group, there were 15 true-positive, 3 false-positive, 4 true-negative, and 0 false-negative PCTAs. This represents a sensitivity of 100% (95% CI, 74.7%-100%) and a specificity of 57% (95% CI, 20%-88%). The mean calculated radiation dose was 5.15 mSv. In the most recent studies, a mean dose of 4.1 mSv was calculated. The ideal time of image acquisition contrast administration varied from 20 to 30 seconds after contrast infusion. Conclusions PCTA is a new technique in anatomic imaging for hyperparathyroidism. In a single-center, single-radiologist retrospective study, it demonstrates excellent accuracy for patients with parathyroid adenomas that are otherwise difficult to localize preoperatively. Preliminary experience suggests that its use may be indicated as a primary imaging modality in the future.
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Affiliation(s)
- Isaac E. Schwartz
- Department of Otolaryngology–Head and Neck Surgery, US Navy Hospital, Naples, Italy
| | - Gregory G. Capra
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - David P. Mullin
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Terence E. Johnson
- Department of Otolaryngology–Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
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Takumi K, Fukukura Y, Hakamada H, Nagano H, Kumagae Y, Arima H, Nakajo A, Yoshiura T. CT features of parathyroid carcinomas: comparison with benign parathyroid lesions. Jpn J Radiol 2019; 37:380-389. [DOI: 10.1007/s11604-019-00825-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 02/28/2019] [Indexed: 12/22/2022]
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Yeh R, Tay YKD, Tabacco G, Dercle L, Kuo JH, Bandeira L, McManus C, Leung DK, Lee JA, Bilezikian JP. Diagnostic Performance of 4D CT and Sestamibi SPECT/CT in Localizing Parathyroid Adenomas in Primary Hyperparathyroidism. Radiology 2019; 291:469-476. [PMID: 30835187 DOI: 10.1148/radiol.2019182122] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There currently is no consensus on the optimal localization procedure and imaging protocol for parathyroid adenoma. Parathyroid four-dimensional (4D) CT has emerged as a promising method for preoperative localization. Purpose To evaluate the diagnostic performance of parathyroid 4D CT and technetium 99m-sestamibi (hereafter, referred to as sestamibi) SPECT/CT in preoperative localization in patients with primary hyperparathyroidism. Materials and Methods This was a single-institution retrospective study of patients with primary hyperparathyroidism who underwent a combined imaging protocol of sestamibi SPECT/CT and 4D CT (noncontrast, contrast agent-enhanced, arterial, and delayed venous phases) acquired in a single setting from February 2013 to May 2016, with subsequent parathyroidectomy within 6 months. Reference standard for correct localization was on the basis of location denoted on operative reports, with pathologic confirmation of parathyroid adenoma or hyperplasia. By using a four-quadrant analysis, sensitivity, specificity, and area under the curve (AUC) for localization of the hyperfunctioning parathyroid gland or glands at sestamibi SPECT/CT and 4D CT were compared, per modality and in combination. Results Four hundred patients (319 women, 81 men; mean age, 61 years ± 14 [standard deviation]) were evaluated. Similar diagnostic performance was found in both combined 4D CT with sestamibi SPECT/CT and 4D CT alone (area under the curve [AUC], 0.88 [95% CI: 0.86, 0.90] and 0.87 [95% CI: 0.85, 0.90], respectively; P = .82). Both modalities outperformed sestamibi SPECT/CT (AUC, 0.78; 95% CI: 0.76, 0.81; P < .001). Four-dimensional CT showed higher sensitivity than did sestamibi SPECT/CT (sensitivity, 79.3% [414 of 522] vs 58.0% [303 of 522], respectively; P < .001). In a subset analysis, 4D CT had higher sensitivity than sestamibi SPECT/CT in patients with single-gland disease (sensitivity, 92.5% [297 of 321] vs 75.1% [241 of 321], respectively; P < .001) and with multigland disease (sensitivity, 58.2% [117 of 201] vs 30.8% [62 of 201], respectively; P < .001). Conclusion Four-dimensional CT provided superior preoperative localization compared with sestamibi SPECT/CT in patients with single and multigland disease. The combination of the two modalities did not improve diagnostic performance compared with four-dimensional CT alone. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Sinha and Oates in this issue.
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Affiliation(s)
- Randy Yeh
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - Yu-Kwang Donovan Tay
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - Gaia Tabacco
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - Laurent Dercle
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - Jennifer H Kuo
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - Leonardo Bandeira
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - Catherine McManus
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - David K Leung
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - James A Lee
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
| | - John P Bilezikian
- From the Department of Radiology, New York-Presbyterian Hospital/Columbia University Medical Center, 622 W 168th St, New York, NY 10032 (R.Y., L.D., D.K.L.); Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, NY (R.Y.); Department of Medicine, Division of Endocrinology (Y.K.D.T., G.T., L.B., J.P.B.), and Department of Surgery, Division of GI/Endocrine Surgery (J.H.K., C.M., J.A.L.), College of Physicians & Surgeons, Columbia University, New York, NY; Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore (Y.K.D.T.); Bristol-Myers Squibb, Princeton, NJ (D.K.L.); and Unit of Endocrinology and Diabetes, Department of Medicine Campus Bio-Medico University of Rome, Italy (G.T.)
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Vu TH, Schellingerhout D, Guha-Thakurta N, Sun J, Wei W, Kappadth SC, Perrier N, Kim EE, Rohren E, Chuang HH, Wong FC. Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT. AJNR Am J Neuroradiol 2018; 40:142-149. [PMID: 30523145 DOI: 10.3174/ajnr.a5901] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/14/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT). MATERIALS AND METHODS We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference. RESULTS Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT. CONCLUSIONS For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT + multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT.
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Affiliation(s)
- T H Vu
- From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
| | - D Schellingerhout
- From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
| | - N Guha-Thakurta
- From the Departments of Diagnostic Radiology (T.H.V., D.S., N.G.-T.)
| | - J Sun
- Biostatistics (J.S., W.W.)
| | - W Wei
- Biostatistics (J.S., W.W.)
| | | | | | - E E Kim
- Department of Radiological Sciences (E.E.K.), University of California at Irvine, Orange, California
| | - E Rohren
- Baylor College of Medicine (E.R.), Houston, Texas
| | - H H Chuang
- Nuclear Medicine (H.H.C., F.C.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - F C Wong
- Nuclear Medicine (H.H.C., F.C.W.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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Binks M, Burrows D, Littlejohn D. A rural perspective on minimally invasive parathyroidectomy: optimal preoperative imaging and patient outcomes. ANZ J Surg 2018; 89:43-47. [PMID: 29873171 DOI: 10.1111/ans.14374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Our retrospective review of prospectively collected data evaluated the efficacy of minimally invasive parathyroidectomy (MIP) and compared preoperative imaging modalities in a rural referral centre. METHODS Patients with a diagnosis of primary hyperparathyroidism underwent surgeon-performed ultrasound (SUS) and technetium-99 m sestamibi (MIBI). Radiologist-performed ultrasound (RUS) was sought when the diagnosis remained in doubt. Four-dimensional computed tomography (4DCT) first replaced RUS in mid-2014, then MIBI as a frontline modality in 2015. MIP was conducted if possible and bilateral neck exploration (BNE) when localization remained doubtful. Treatment was evaluated by histopathology and serum parathyroid hormone and calcium levels at 6 weeks. RESULTS A total of 122 of 165 (73.9%) glands were removed by MIP and 43 of 165 (26.1%) by BNE. Of 15 cases with non-localizing preoperative investigations, one patient had a negative BNE. A total of 160 of 165 (97.0%) patients underwent a successful operation, with five (3.0%) suffering persistent post-operative hypercalcaemia. SUS had a sensitivity of 79.4% (131/165) and a positive predictive value (PPV) of 97.0% (131/135). MIBI had a sensitivity of 60.0% (81/135) and a PPV of 95.3% (81/85). RUS produced a sensitivity of 65.5% (76/116) and PPV of 98.7% (76/77). When used as a second-line modality, 4DCT had a sensitivity of 76.9% (10/13) and PPV of 100%. The sensitivity and PPV were 85.7% (18/21) and 94.7% (18/19) after 4DCT's promotion to first-line use. CONCLUSION MIP can be safely performed in rural centres of adequate volume. We recommend that operations be guided by SUS with routine use of an adjunctive modality. Our study has seen 4DCT replace MIBI in this regard.
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Affiliation(s)
- Matthew Binks
- Breast and Endocrine Surgical Unit, Department of Surgery, Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia.,Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Denbigh Burrows
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - David Littlejohn
- Breast and Endocrine Surgical Unit, Department of Surgery, Wagga Wagga Rural Referral Hospital, Wagga Wagga, New South Wales, Australia
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Dynamic CT for Parathyroid Adenoma Detection: How Does Radiation Dose Compare With Nuclear Medicine? AJR Am J Roentgenol 2018; 210:1118-1122. [DOI: 10.2214/ajr.17.18674] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Cunha-Bezerra P, Vieira R, Amaral F, Cartaxo H, Lima T, Montarroyos U, Bandeira F. Better performance of four-dimension computed tomography as a localization procedure in normocalcemic primary hyperparathyroidism. J Med Imaging Radiat Oncol 2018; 62:493-498. [PMID: 29656552 DOI: 10.1111/1754-9485.12728] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 02/24/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The multi-phase or four-dimensional computed tomography (4D CT) has emerged as a promising technique for preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism (PHPT), but little is known about its accuracy in patients with normocalcemic primary hyperparathyroidism (NPHPT). METHODS A total of 18 patients diagnosed with PHPT underwent three methods of preoperative localization (4D CT, TC-99-Sestamibi scintigraphy and ultrasonography). After surgery, the results of imaging were compared with operative findings, pathological and biochemical data to evaluate the sensitivity and of each localization procedure. RESULTS In NPHPT the sensitivity for identifying the parathyroid lesion, according to presentation of PHPT (hypercalcemic or normocalcemic), was better with 4DCT in comparison to USG and scintigraphy. In these patients, the sensitivity for lateralization was as follows: USG: 22% (95% CI 0-44.9), scintigraphy: 11.1% (95% CI 0-31.6), 4DCT: 55.6% (95% CI 23.1-88). In hypercalcemic patients the results were as follows: USG: 58.3% (95% CI 30.4-86.2), scintigraphy: 75% (95% CI 50.5-99.5), 4DCT: 75% (95% CI 50.5-99.5). There was a poor agreement between the three procedures in the identification of the parathyroid lesions, with Kappa coeficients of 0.292 and 0.01 for scintigraphy and 4DCT, respectively, in comparison to USG. CONCLUSION Our data showed that 4DCT had a better performance as a preoperative localization procedure of the parathyroid lesion in patients with NPHPT.
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Affiliation(s)
- Phelipe Cunha-Bezerra
- Head and Neck Unit, Department of Surgery, Oswaldo Cruz Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Ricardo Vieira
- Head and Neck Unit, Department of Surgery, Oswaldo Cruz Hospital, University of Pernambuco Medical School, Recife, Brazil
| | - Fernando Amaral
- Radiology Department, Hospital Barão de Lucena (SUS/PE), Recife, Brazil
| | | | - Túlio Lima
- Pathology Division, Instituto de Medicina Integral Prof. Fernando Figueira (Imip), Recife, Brazil
| | | | - Francisco Bandeira
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Hospital Agamenon Magalhães, University of Pernambuco Medical School, Recife, Brazil
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Tay YKD, Yeh R, Kuo JH, McManus C, Lee JA, Bilezikian JP. Pre-operative localization of abnormal parathyroid tissue by 99mTc-sestamibi in primary hyperparathyroidism using four-quadrant site analysis: an evaluation of the predictive value of vitamin D deficiency. Endocrine 2018; 60:36-45. [PMID: 29404903 DOI: 10.1007/s12020-018-1528-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 01/09/2018] [Indexed: 10/18/2022]
Abstract
CONTEXT Accurate preoperative localization of abnormal parathyroid tissue aids importantly in minimally invasive parathyroidectomy in patients with primary hyperparathyroidism. Vitamin D deficiency may possibly influence the success and characteristics of pre-operative localization because it is associated with more active disease and possibly larger adenomas. This could increase the sensitivity of the sestamibi to identify abnormal parathyroid tissue, but earlier reports are conflicting. Vitamin D deficiency could also influence the nature of preoperative localization because it could lead to multi-gland stimulation of parathyroid tissue giving an appearance of multi-gland disease, which may lower accuracy of preoperative localization with sestamibi. OBJECTIVE To examine the relationship between vitamin D deficiency and correct parathyroid tissue localization by four-pole thyroid quadrant analysis. DESIGN Retrospective study. SETTING Referral center. PARTICIPANTS A total of 138 patients were divided into three groups according to the level of 25OHD; <20 ng/mL (vitamin D deficient), ≥20 to <30 ng/mL (vitamin D insufficient) and ≥30 ng/mL (vitamin D replete). MAIN OUTCOMES Quadrant localization using 99mTc-sestamibi/SPECT. RESULTS Among those with single-gland disease, the proportion of patients with correct quadrant localization were 60.0, 68.3 and 63.5% (p = 0.778), and the accuracy of sestamibi was 89.3, 90.6 and 89.9% for the deficient, insufficiency and replete groups, respectively. Among those with multi-gland disease, the proportion of patients with correct quadrant localization were 50.0, 25.0 and 18.2% (p = 0.619) while the accuracy was 50.0, 50.0 and 45.5%, respectively. Multi-gland disease did not occur more frequently in any of the three groups (p = 0.296). CONCLUSIONS Vitamin D levels do not affect the accuracy of preoperative localization with sestamibi.
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Affiliation(s)
- Yu-Kwang Donovan Tay
- Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
- Department of Medicine, Sengkang Health, Singapore, Singapore.
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore.
| | - Randy Yeh
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Jennifer H Kuo
- Department of GI/Endocrine Surgery, Columbia University, New York, NY, USA
| | - Catherine McManus
- Department of GI/Endocrine Surgery, Columbia University, New York, NY, USA
| | - James A Lee
- Department of GI/Endocrine Surgery, Columbia University, New York, NY, USA
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons, Columbia University, New York, NY, USA.
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Fisher SB, Perrier ND. Incidental Hypercalcemia and the Parathyroid. J Am Coll Surg 2018; 226:1181-1189. [PMID: 29574176 DOI: 10.1016/j.jamcollsurg.2018.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Sarah B Fisher
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Nancy D Perrier
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Sho S, Yuen AD, Yeh MW, Livhits MJ, Sepahdari AR. Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy. JAMA Surg 2018; 152:1141-1147. [PMID: 28793141 DOI: 10.1001/jamasurg.2017.2649] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Parathyroid 4-dimensional computed tomographic scans (4D-CTs) have emerged as an accurate and cost-effective initial localization study for patients with primary hyperparathyroidism. However, potential limitations and factors affecting the accuracy of preoperative 4D-CTs remain poorly defined. Objectives To characterize factors associated with missed parathyroid lesions on preoperative 4D-CTs and to investigate patterns of commonly observed errors. Design, Setting, and Participants A prospectively accrued patient database was analyzed from September 1, 2011, through October 31, 2016. The study was performed in a tertiary referral center. Consecutive patients with primary hyperparathyroidism undergoing preoperative 4D-CTs and subsequent parathyroidectomy were included in the study. Main Outcomes and Measures Discordance between preoperative 4D-CTs and intraoperative findings in the number and location of abnormal parathyroid lesions. Results Of 411 patients studied (mean [SD] age, 59 [14] years; 325 [79.1%] female), 123 (29.9%) had discordance between preoperative 4D-CTs and intraoperative findings. Among the 411 patients, 75 (18.2%) had major discordance, including incorrectly localized adenoma on the contralateral side of the neck, missed double adenoma, and absence of any abnormal lesion detected on 4D-CTs. Compared with concordant cases, discordant cases had higher frequencies of multigland disease (66.7% [82 of 123] vs 24.3% [70 of 288], P < .001) and multinodular goiter or thyroid nodule (40.7% [50 of 123] vs 29.2% [84 of 288], P = .02). Missed parathyroid lesions were smaller (mean [SD], 0.86 [0.29] vs 1.24 [0.50] cm; P < .001) and were more likely to be in the inferior position (65.4% [87 of 133] vs 38.1% [177 of 465], P < .001). Parathyroid lesion size of 10 mm or less (odds ratio [OR], 4.37; 95% CI, 2.24-8.54), multigland disease (OR, 7.63; 95% CI, 3.49-16.69), multinodular goiter or thyroid nodule (OR, 1.82; 95% CI, 1.01-3.28), and parathyroid lesion in the inferior position (OR, 6.82; 95% CI, 3.10-14.99) were independently associated with discordant 4D-CT results. Conclusions and Relevance Multigland disease was most strongly associated with discordance between preoperative 4D-CTs and intraoperative findings, followed by parathyroid lesion in the inferior position and parathyroid lesion size of 10 mm or less. Awareness of these potential pitfalls may allow surgeons to better leverage this new localization technique in preoperative planning and intraoperative troubleshooting.
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Affiliation(s)
- Shonan Sho
- Section of Endocrine Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Alexander D Yuen
- Section of Endocrine Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Michael W Yeh
- Section of Endocrine Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Masha J Livhits
- Section of Endocrine Surgery, David Geffen School of Medicine, University of California, Los Angeles
| | - Ali R Sepahdari
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles
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Abstract
Imaging plays a multifaceted role in the diagnosis and characterization of head and neck oncological patients and is integral to their care. Given the complexity of treatment, a multimodality approach is often necessary. With the advent of new technologies, imaging can also be used to predict tumor behavior and treatment response. In this chapter, with selected case examples, we describe the various imaging modalities available and offer suggestions on their utilization.
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Affiliation(s)
- Ravi Prasad
- Cedars-Sinai Medical Center, Los Angeles, USA.
| | - Beth Chen
- City of Hope National Medical Center, Duarte, 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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Parina R, Drotar P, Westfall E, Bailey J, Fang HK, Milas M. Mediastinal Parathyroid Adenoma Resection Through Robotic Video-Assisted Thoracoscopy Utilizing Firefly Fluorescence. VideoEndocrinology 2017. [DOI: 10.1089/ve.2017.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ralitza Parina
- Department of Surgery, Endocrine Surgery Center, Banner University Medical Center Phoenix and University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Persida Drotar
- Department of Surgery, Endocrine Surgery Center, Banner University Medical Center Phoenix and University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Elizabeth Westfall
- Department of Radiology, Banner University Medical Center Phoenix and University of Arizona College of Medicine Phoenix, Phoenix, Arizona
| | - Joan Bailey
- Midtown Endocrine Associates, PC, Phoenix, Arizona
| | - H. Kenith Fang
- Department of Surgery, Banner University Medical Center Phoenix, Phoenix, Arizona. Phoenix Cardiac Surgery, Phoenix, Arizona
| | - Mira Milas
- Department of Surgery, Endocrine Surgery Center, Banner University Medical Center Phoenix and University of Arizona College of Medicine Phoenix, Phoenix, Arizona
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Christakis I, Vu T, Chuang HH, Fellman B, Figueroa AM, Williams MD, Busaidy NL, Perrier ND. The diagnostic accuracy of neck ultrasound, 4D-Computed tomographyand sestamibi imaging in parathyroid carcinoma. Eur J Radiol 2017; 95:82-88. [DOI: 10.1016/j.ejrad.2017.07.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 06/17/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023]
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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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40
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Silver E, Sadeghi N, Knoll S, Taheri MR. Utility of Single-Phase Computed Tomography in Identifying Parathyroid Adenomas: A Feasibility Study. Curr Probl Diagn Radiol 2017; 47:90-93. [PMID: 28705526 DOI: 10.1067/j.cpradiol.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/15/2017] [Accepted: 05/16/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We tested the hypothesis that a single-phase neck computed tomography (CT) is not inferior to multiphase neck CT (MPNCT), ultrasound, or nuclear medicine sestamibi scan in identifying parathyroid adenomas (PAs). METHODS A total of 29 patients who had an MPNCT for the evaluation of a PA were identified; 11 patients met the inclusion criteria. During the 30-second arterial phase CT (APNCT), a normalized Hounsfield unit of suspected PA was compared to Hounsfield unit of a normal-appearing level I and a level II lymph node. A PA was defined as a lesion with a ratio of greater than 1.4 when compared to the level I and level II lymph node. This cutoff was determined based on the normalized ratios between level II and level I lymph nodes. Results of intraoperative parathyroid hormone assays and surgical pathology were used to validate the accuracy of this technique. RESULTS The sensitivity of this method in APNCT is 90.9% whereas positive predictive value is 100%. The sensitivity or positive predictive value of ultrasound and nuclear medicine are 60% or 100% and 90% or 100%, respectively. CONCLUSION The sensitivity of APNCT is equivalent to that of MPNCT in identifying PA.
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Affiliation(s)
- Ethan Silver
- Department of Radiology, The George Washington University Hospital, Washington, DC.
| | - Nader Sadeghi
- Department of Otolaryngology, The George Washington University Hospital, Washington, DC
| | - Stanley Knoll
- Department of General Surgery, The George Washington University Hospital, Washington, DC
| | - M Reza Taheri
- Department of Radiology, The George Washington University Hospital, Washington, DC
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41
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Selective venous sampling for primary hyperparathyroidism: how to perform an examination and interpret the results with reference to thyroid vein anatomy. Jpn J Radiol 2017. [DOI: 10.1007/s11604-017-0658-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Elhelf IAS, Kademian JC, Moritani T, Capizzano AE, Policeni B, Maley J. Ectopic mediastinal parathyroid adenoma localized with four-dimensional CT: a case report. Radiol Case Rep 2017; 12:247-250. [PMID: 28491162 PMCID: PMC5417727 DOI: 10.1016/j.radcr.2017.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/06/2017] [Accepted: 01/13/2017] [Indexed: 11/18/2022] Open
Abstract
We present a case of an ectopic mediastinal parathyroid adenoma in a 58-year-old male patient. We show how different imaging modalities were successfully used to reach a diagnosis. We particularly focus on the role of four-dimensional CT scan in preoperative localization of ectopic adenomas and discuss how diverse imaging modalities can be integrated in the workup of ectopic parathyroid adenomas.
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Affiliation(s)
- Islam A. Shehata Elhelf
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa city, IA, USA
- Department of Diagnostic and Interventional Radiology, Cairo University, Cairo, Egypt
- Corresponding author.
| | - Jack C. Kademian
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa city, IA, USA
| | - Toshio Moritani
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa city, IA, USA
| | - Aristides E. Capizzano
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa city, IA, USA
| | - Bruno Policeni
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa city, IA, USA
| | - Joan Maley
- Department of Diagnostic Radiology, University of Iowa Hospitals and Clinics, Iowa city, IA, USA
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Forghani R, Mukherji SK. Advanced dual-energy CT applications for the evaluation of the soft tissues of the neck. Clin Radiol 2017; 73:70-80. [PMID: 28476243 DOI: 10.1016/j.crad.2017.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 03/28/2017] [Accepted: 04/03/2017] [Indexed: 12/16/2022]
Abstract
There are multiple emerging advanced computed tomography (CT) applications for the evaluation of the neck, many based on dual-energy CT (DECT). DECT is an advanced form of CT in which scan acquisition is performed at two different energies, enabling spectral tissue characterisation beyond what is possible with conventional single-energy CT and potentially providing a new horizon for quantitative analysis and tissue characterisation, particularly in oncological imaging. The purpose of this review is to familiarise the reader with DECT principles and review different clinical applications for the evaluation of the soft tissues of the neck. The article will begin with an overview of DECT scan acquisition, material characterisation, reconstructions, and basic considerations for implementation in the clinical setting. This will then be followed by a review of different clinical applications. The focus will be on oncological imaging, but artefact reduction and other miscellaneous applications will also be discussed.
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Affiliation(s)
- R Forghani
- Department of Radiology, Jewish General Hospital & McGill University, 3755 Côte-Ste-Catherine Road, Montreal, Quebec, Canada, H3T 1E2; Segal Cancer Centre and Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte-Ste-Catherine Road, Montreal, Quebec, Canada, H3T 1E2.
| | - S K Mukherji
- Department of Radiology, Michigan State University, 846 Service Rd, East Lansing, Michigan 48824, USA
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Roele ED, Timmer VCML, Vaassen LAA, van Kroonenburgh AMJL, Postma AA. Dual-Energy CT in Head and Neck Imaging. CURRENT RADIOLOGY REPORTS 2017; 5:19. [PMID: 28435761 PMCID: PMC5371622 DOI: 10.1007/s40134-017-0213-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To explain the technique of Dual-energy CT (DECT) and highlight its applications and advantages in head and neck radiology. RECENT FINDINGS Using DECT, additional datasets can be created next to conventional images. In head and neck radiology, three material decomposition algorithms can be used for improved lesion detection and delineation of the tumor. Iodine concentration measurements can aid in differentiating malignant from nonmalignant lymph nodes and benign posttreatment changes from tumor recurrence. Virtual non-calcium images can be used for detection of bone marrow edema. Virtual mono-energetic imaging can be useful for improved iodine conspicuity at lower keV and for reduction of metallic artifacts and increase in signal-to-noise ratio at higher keV. SUMMARY DECT and its additional reconstructions can play an important role in head and neck cancer patients, from initial diagnosis and staging, to therapy planning, evaluation of treatment response and follow-up. Moreover, it can be helpful in imaging of infections and inflammation and parathyroid imaging as supplementary reconstructions can be obtained at lower or equal radiation dose compared with conventional single energy scanning.
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Affiliation(s)
- Elise D. Roele
- Department of Radiology, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Veronique C. M. L. Timmer
- Department of Cranio and Maxillofacial Surgery, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Lauretta A. A. Vaassen
- Department of Cranio and Maxillofacial Surgery, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | | | - A. A. Postma
- Department of Radiology, Maastricht University Medical Centre+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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45
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Liddy S, Worsley D, Torreggiani W, Feeney J. Preoperative Imaging in Primary Hyperparathyroidism: Literature Review and Recommendations. Can Assoc Radiol J 2017; 68:47-55. [DOI: 10.1016/j.carj.2016.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/20/2016] [Accepted: 07/06/2016] [Indexed: 12/17/2022] Open
Affiliation(s)
- Stephen Liddy
- Department of Radiology, Tallaght Hospital, Tallaght, Dublin, Ireland
| | - Daniel Worsley
- Division of Nuclear Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - John Feeney
- Department of Radiology, Tallaght Hospital, Tallaght, Dublin, Ireland
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46
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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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47
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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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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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50
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Keidar Z, Solomonov E, Karry R, Frenkel A, Israel O, Mekel M. Preoperative [99mTc]MIBI SPECT/CT Interpretation Criteria for Localization of Parathyroid Adenomas—Correlation with Surgical Findings. Mol Imaging Biol 2016; 19:265-270. [DOI: 10.1007/s11307-016-1013-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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