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Scheepers MHMC, Al-Difaie Z, Brandts L, Peeters A, Winkens B, Al-Taher M, Engelen SME, Lubbers T, Havekes B, Bouvy ND, Postma AA. Diagnostic Performance of Magnetic Resonance Imaging for Parathyroid Localization of Primary Hyperparathyroidism: A Systematic Review. Diagnostics (Basel) 2023; 14:25. [PMID: 38201335 PMCID: PMC10802165 DOI: 10.3390/diagnostics14010025] [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: 11/20/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Accurate preoperative localization is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Preoperative localization can be challenging in patients with recurrent and/or multigland disease (MGD). This has led clinicians to investigate multiple imaging techniques, most of which are associated with radiation exposure. Magnetic resonance imaging (MRI) offers ionizing radiation-free and accurate imaging, making it an attractive alternative imaging modality. The objective of this systematic review is to provide an overview of the diagnostic performance of MRI in the localization of PHPT. PubMed and Embase libraries were searched from 1 January 2000 to 31 March 2023. Studies were included that investigated MRI techniques for the localization of PHPT. The exclusion criteria were (1) secondary/tertiary hyperparathyroidism, (2) studies that provided no diagnostic performance values, (3) studies published before 2000, and (4) studies using 0.5 Tesla MRI scanners. Twenty-four articles were included in the systematic review, with a total of 1127 patients with PHPT. In 14 studies investigating conventional MRI for PHPT localization, sensitivities varied between 39.1% and 94.3%. When employing more advanced MRI protocols like 4D MRI for PHPT localization in 11 studies, sensitivities ranged from 55.6% to 100%. The combination of MR imaging with functional techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy, with sensitivities ranging from 84.2% to 100% in five studies. Despite the limitations of the available evidence, the results of this review indicate that the combination of MR imaging with functional imaging techniques such as 18F-FCH-PET/MRI yielded the highest diagnostic accuracy. Further research on emerging MR imaging modalities, such as 4D MRI and PET/MRI, is warranted, as MRI exposes patients to minimal or no ionizing radiation compared to other imaging modalities.
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Affiliation(s)
- Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands;
| | - Mahdi Al-Taher
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Sanne M. E. Engelen
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Tim Lubbers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Bas Havekes
- Department of Internal Medicine, Division of Endocrinology and Metabolic Disease, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands (S.M.E.E.)
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences (MHENS), Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands;
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Wazzan M. Absolute and Relative Washout Rates Associated With Parathyroid Adenoma. Cureus 2023; 15:e48947. [PMID: 38024058 PMCID: PMC10655491 DOI: 10.7759/cureus.48947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Parathyroid adenoma is a benign parathyroid gland tumor that causes excessive parathyroid hormone production, leading to primary hyperparathyroidism. High serum calcium levels characterize it. Accurate diagnosis and localization of adenomas are crucial for effective surgical management. Computed tomography is a fundamental imaging technique used to identify and characterize parathyroid adenomas. This study aimed to provide a comprehensive overview of the absolute and relative contrast washout rates of parathyroid adenoma and the thyroid gland, and compare enhancement patterns to establish the absolute and relative washout rates of parathyroid adenoma. Materials & methods This retrospective study analyzes the CT findings of 33 patients with histopathologically proven parathyroid adenomas. All patients with 4D CT scans have been included with no exclusion criteria. The mean attenuation was measured in Hounsfield units for the parathyroid adenoma and thyroid gland in the non-enhancing, arterial, venous, and delayed phases, depending on the region of interest. All statistical analyses were performed using SPSS (IBM Corp., Armonk, NY, USA). Student's t-test was used to evaluate the differences in measurements between the parathyroid adenoma and thyroid tissue. One-way ANOVA was used to evaluate the difference in calculations between the parathyroid adenoma and thyroid tissue. P-values <0.001 were considered statistically significant. Results The most common location of parathyroid adenomas is inferior to the thyroid gland. The average pre-contrast attenuation of the parathyroid adenoma is 61.8 ± 15.5 HU compared to 105.5 ± 15.2 HU of the thyroid gland. The arterial attenuation of the parathyroid adenoma is 170.3 ± 40.7 HU, relatively comparable to the thyroid gland arterial attenuation, which is 188.0 ± 9.6 HU. The venous and delayed-phase attenuation of the parathyroid adenoma were 146.8 ± 37.5 and 96.8 ± 26.7 HU, respectively, and 178.8 ± 20.2 HU and 149.3 ± 15.2 HU for the thyroid gland, respectively. The calculated absolute and relative arterial washout rates for the parathyroid adenoma were 69.4 ± 13.4% and 43.2 ± 8.0%, respectively, as compared to 46.4 ± 9.9% and 20.6 ± 6.7% for the thyroid gland. The calculated absolute and relative venous washout rates for the parathyroid adenoma were 58.0 ± 21.4% and 33.0 ± 13.7%, respectively, as compared to 37.2 ± 17.2% and 15.9 ± 9.6% for the thyroid gland. Conclusions Parathyroid adenoma demonstrated a significantly higher washout rate than the thyroid gland tissue. Absolute arterial washout ≥69% and relative arterial washout ≥43% indicate parathyroid adenoma. Moreover, absolute venous washout ≥58% and relative venous washout ≥33% can be considered diagnostic factors for parathyroid adenoma. Further, pre-contrast attenuation of <60 Hounsfield units has a substantial predictive value for parathyroid adenoma in addition to the described washout rate. Increased awareness of the washout rate can increase the success rate of four-dimensional computed tomography interpretation.
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Affiliation(s)
- Mohammad Wazzan
- Department of Radiology, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
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Al-Difaie Z, Scheepers MHMC, Engelen SME, Havekes B, Bouvy ND, Postma AA. Diagnostic Value of Four-Dimensional Dynamic Computed Tomography for Primary Hyperparathyroidism in Patients with Low Baseline Parathyroid Hormone Levels. Diagnostics (Basel) 2023; 13:2621. [PMID: 37627880 PMCID: PMC10453623 DOI: 10.3390/diagnostics13162621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 08/27/2023] Open
Abstract
Low baseline levels of parathyroid hormone (PTH) are associated with a higher rate of multiglandular disease, lower localization rates of preoperative imaging modalities, and a higher rate of unsuccessful minimally invasive parathyroidectomies. The objective of this study is to assess the diagnostic value of four-dimensional dynamic computed tomography (4D-CT) in localizing primary hyperparathyroidism (pHPT) in patients with low baseline PTH levels, compared to patients with high baseline PTH levels. Patients with pHPT who received a 4D-CT scan as part of their standard diagnostic evaluation were divided into two groups based on the following criteria: (1) preoperative PTH levels less than 100 pg/mL and (2) patients with preoperative PTH levels greater than 100 pg/mL. All patients underwent parathyroidectomy based on 4D-CT findings, with intraoperative parathyroid hormone monitoring. The lesion-based sensitivity of 4D-CT was 88% in patients with low baseline PTH levels and 94.7% in patients with high baseline PTH levels (p = 0.33). However, the success rate of image-guided resection based on 4D-CT findings was 71.4% in the low baseline PTH group compared to 90.6% in the high baseline PTH group (p = 0.06). Our study demonstrated that 4D-CT has a high lesion-based sensitivity in patients with pHPT and low baseline PTH levels but led to a relatively low rate of successful image-guided resection in patients with low baseline PTH levels. Therefore, it is important to exercise increased caution during 4D-CT-guided surgical exploration of patients with low baseline PTH levels to ensure successful surgical resection of all parathyroid lesions.
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Affiliation(s)
- Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (Z.A.-D.); (M.H.M.C.S.)
| | - Max H. M. C. Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (Z.A.-D.); (M.H.M.C.S.)
| | - Sanne M. E. Engelen
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Bastiaan Havekes
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Nicole D. Bouvy
- Department of Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
| | - Alida A. Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Sciences (MHENS), Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
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Al-Difaie Z, Scheepers MHMC, Bouvy ND, Engelen S, Havekes B, Postma AA. Can virtual non-contrast imaging replace true non-contrast imaging in multiphase scanning of the neck region? Acta Radiol Open 2023; 12:20584601231205159. [PMID: 37767056 PMCID: PMC10521284 DOI: 10.1177/20584601231205159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Background Dual-energy computed tomography (DECT) is an advanced imaging method that enables reconstruction of virtual non-contrast (VNC) images from a contrast-enhanced acquisition. This has the potential to reduce radiation exposure by eliminating the need for a true non-contrast (TNC) phase. Purpose The purpose is to evaluate the feasibility of VNC images in the neck region. Materials and methods A total of 100 patients underwent a DECT scan as part of diagnostic workup of primary hyperparathyroidism. VNC images were reconstructed from 30 s (arterial) and 50 s (venous) post-contrast scans. Regions of interest (ROIs) were placed in thyroid tissue, lymph node, carotid artery, jugular vein, fat, and sternocleidomastoid muscle. Mean densities of all anatomical structures were compared between VNC and TNC images. Results For all anatomical structures except the thyroid gland, the difference in mean density between TNC and VNC images was less than 15 HU. The mean difference in density between TNC and VNC images of the thyroid was 53.2 HU (95% CI 46.8; 59.6, p = <0.001). Conclusion This study demonstrated an acceptable agreement in density between true non-contrast and virtual non-contrast images for most anatomical structures in the neck region. Therefore, VNC images may have the potential to replace TNC images in the neck. However, due to significant differences in CT density of thyroid tissue, true non-contrast imaging cannot be directly substituted by virtual non-contrast imaging when examining the thyroid and its surrounding tissue.
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Affiliation(s)
- Zaid Al-Difaie
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Max HMC Scheepers
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sanne Engelen
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bas Havekes
- Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, School for Mental Health and Neuroscience, Neuroradiology, Maastricht University Medical Center, Maastricht, The Netherlands
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Guo M, Lustig DB, Lee D, Manhas N, Wiseman SM. Use of dual energy computed tomography versus conventional techniques for preoperative localization in primary hyperparathyroidism: Effect of preoperative calcium and parathyroid hormone levels. Am J Surg 2023; 225:852-856. [PMID: 36669941 DOI: 10.1016/j.amjsurg.2023.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/13/2022] [Accepted: 01/15/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND We aimed to investigate the association of preoperative calcium and parathyroid hormone (PTH) levels with sensitivity and accuracy of dual energy computed tomography (DECT), single-photon emission CT with 99mTc-sestamibi (CT-MIBI), and ultrasound (US) for pre-operative localization primary hyperparathyroid (PHP) patients. METHODS Patients undergoing parathyroidectomy for PHP at a tertiary care facility who underwent DECT, CT-MIBI and US between 2012 and 2021 were stratified by preoperative calcium and PTH levels. RESULTS Of 278 patients, those with high calcium and PTH levels had a higher sensitivity and accuracy with DECT (87.7%, 85.2%) compared to CT-MIBI (82.3%, 79.0%), and US (61.7%, 53.1%). DECT was more sensitive and accurate than other preoperative localization techniques in subgroups with normal PTH (DECT sensitivity 60.9%, accuracy 52.1%) and normal calcium levels (41.7%, 33.3%). CONCLUSION Preoperative calcium and PTH were associated with sensitivity and accuracy of pre-operative localization in PHP. DECT was sensitive and accurate for preoperative localization compared to other first-line imaging techniques.
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Affiliation(s)
- Michael Guo
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Daniel B Lustig
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Debon Lee
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Neraj Manhas
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, BC, Canada.
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7
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Kattar N, Migneron M, Debakey MS, Haidari M, Pou AM, McCoul ED. Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2022; 148:448-456. [PMID: 35357400 PMCID: PMC8972149 DOI: 10.1001/jamaoto.2022.0271] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Importance Emerging computed tomographic (CT) imaging techniques for the localization of primary hyperparathyroidism (PHPT) may be superior to the current imaging standard, thus necessitating a critical review and pooling of available evidence. Objective Primary hyperparathyroidism requires accurate imaging to guide definitive surgical management. Advanced techniques including 4-dimensional computed tomographic (4D-CT) scan have been investigated over the past decade. We sought to evaluate the efficacy of these emerging imaging techniques through pooled analysis of the existing evidence. Data Sources PubMed, Embase, and Web of Science databases were queried for original English articles without any restrictions on date. Study Selection We included comparative observational studies but excluded animal studies, case reports, and case series. Overall, 353 abstracts were screened independently by 2 investigators along with a third reviewer to resolve conflicts. A total of 26 full-text articles were included in this review. Data Extraction and Synthesis This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data was independently extracted by 2 investigators and subsequently pooled into a meta-analysis using a random-effects model. Main Outcomes and Measures Measures of imaging diagnostic performance such as sensitivity, specificity, positive predictive value, and negative predictive value were the primary outcomes of interest. Results Overall, of 34 articles screened, 26 met criteria for qualitative synthesis, and 23 of these were appropriate for meta-analysis. Of the 26 studies included, there were 5845 patients, of which 4176 were women (79.2%). The average of mean ages reported in 23 studies was 60.9 years. Meta-analysis in all patients with PHPT revealed pooled sensitivity that was greater with 4D-CT (81%; 95% CI, 77%-84%; I2 = 88%) compared with the current first-line modality of sestamibi-single-photon emission CT (SPECT/CT) (65%; 95% CI, 59%-70%; I2 = 93%). For patients with recurrent PHPT requiring reoperation, 4D-CT pooled sensitivity was 81% (95% CI, 64%-98%; I2 = 93%) in contrast to 53% (95% CI, 35%-71%; I2 = 81%) for sestamibi-SPECT/CT. The overall quality of the 26 studies was moderate with a median (range) Methodological Index for Nonrandomized Studies score for all included studies of 15.5 (13-19). Conclusions and Relevance The findings of this systematic review and with meta-analyses of numerous studies from the past decade suggest that the 4D-CT can be more sensitive and specific than sestamibi-SPECT/CT in localizing PHPT. More research is needed to determine the clinical significance of this improvement in localization.
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Affiliation(s)
- Nrusheel Kattar
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Matthew Migneron
- Department of Otolaryngology–Head and Neck Surgery, Tulane University, New Orleans, Louisiana
| | - Michael S. Debakey
- Department of Otolaryngology–Head and Neck Surgery, Tulane University, New Orleans, Louisiana
| | - Muhib Haidari
- Department of Otolaryngology–Head and Neck Surgery, Tulane University, New Orleans, Louisiana
| | - Anna M. Pou
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Edward D. McCoul
- Department of Otorhinolaryngology, Ochsner Clinic Foundation, New Orleans, Louisiana,Department of Otolaryngology–Head and Neck Surgery, Tulane University, New Orleans, Louisiana,Ochsner Clinical School, University of Queensland, Brisbane, Australia
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Maraia D, Hemmerdinger S, Chiarolanzio P, Mehta H, Ali S, Gomes W, Schefflein J, High M, Gulko E. Dual-layer spectral CT virtual-non-contrast images aid in parathyroid adenoma analysis and radiation dose reduction: confirmation of findings from dual-energy CT. Clin Imaging 2022; 84:113-117. [DOI: 10.1016/j.clinimag.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
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Bunch PM, Pavlina AA, Lipford ME, Sachs JR. Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images. AJNR Am J Neuroradiol 2021; 42:2001-2008. [PMID: 34475194 DOI: 10.3174/ajnr.a7265] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE In parathyroid CT, a noncontrast phase aids discrimination of parathyroid lesions (not iodine-containing) from thyroid tissue (iodine-containing). When thyroid iodine is pathologically diminished, this differentiation is difficult with standard CT. Because the attenuation of an element is maximal near its K-edge (iodine = 33.2 keV), we hypothesized that dual-energy CT 40-keV virtual monoenergetic images will accentuate thyroid iodine relative to standard images, improving the differentiation of thyroid from parathyroid lesions. Our purpose was to test this hypothesis through quantitative assessment of Hounsfield unit attenuation and contrast-to-noise on dual-energy CT standard (70-keV) and 40-keV noncontrast images. MATERIALS AND METHODS For this retrospective study including 20 dual-energy parathyroid CTs, we used an ROI-based analysis to assess the attenuation of thyroid tissue, parathyroid lesions, and sternocleidomastoid muscle as well as corresponding contrast-to-noise on standard and 40- keV noncontrast images. Wilcoxon signed rank tests were performed to compare differences between 70 and 40 keV. RESULTS Absolute and percentage increases in attenuation at 40 keV were significantly greater for thyroid gland than for parathyroid lesions and sternocleidomastoid muscle (P < .001 for all). Significant increases in the contrast-to-noise of thyroid relative to parathyroid lesions (median increase, 0.8; P < .001) and relative to sternocleidomastoid muscle (median increase, 1.3; P < .001) were observed at 40 keV relative to 70 keV. CONCLUSIONS Forty-kiloelectron volt virtual monoenergetic images facilitate discrimination of parathyroid lesions from thyroid tissue by significantly increasing thyroid attenuation and associated contrast-to-noise. These findings are particularly relevant for parathyroid lesions that exhibit isoattenuation to the thyroid on parathyroid CT arterial and venous phases and could, therefore, be missed without the noncontrast phase.
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Affiliation(s)
- P M Bunch
- From the Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - A A Pavlina
- From the Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - M E Lipford
- From the Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - J R Sachs
- From the Department of Radiology, Wake Forest School of Medicine, Winston Salem, North Carolina
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Lee SW, Shim SR, Jeong SY, Kim SJ. Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism: A Systematic Review and Network Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 147:692-706. [PMID: 34081083 DOI: 10.1001/jamaoto.2021.0915] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Importance Accurate preoperative localization of primary hyperparathyroidism (pHPT) is an important and challenging issue for a successful parathyroidectomy. Although new imaging modalities have been introduced during the past decade, direct comparative studies on advanced imaging techniques are limited. Objective To compare the performance of different preoperative imaging modalities for the localization of pHPT by performing a network meta-analysis (NMA). Data Sources PubMed, Embase, and the Cochrane Library were searched from the earliest available indexing date through September 28, 2020. Study Selection The inclusion criteria were diagnostic tests with sensitivities of 2 or more different preoperative imaging modalities for the same indivduals. Data Extraction and Synthesis Two researchers independently reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension statement of health care intervention guidelines for network meta-analyses. Main Outcomes and Measures After classifying various imaging modalities into 8 representative imaging categories, the pooled estimation between the odds ratio and 95% credible intervals (CrIs) was calculated in the sensitivity for localization of pHPT. The surface under the cumulative ranking curve (SUCRA) values were obtained to calculate the probability of each imaging modality being the most effective diagnostic method. Results A total of 8495 patients from 119 direct comparative studies using 2 or more imaging modalities for localization of pHPT were included. The sensitivity of choline positron emission tomography and computed tomography (PET-CT) was significantly higher than that of technetium 99m sestamibi single-photon emission computed tomography (MIBI SPECT) in both patient-based and lesion-based analyses (patient-based analysis: odds ratio, 5.22; 95% CrI, 2.36-11.80; lesion-based analysis: odds ratio, 17.70; 95% CrI, 5.79-60.10). Among 8 representative imaging modality categories, choline PET-CT showed the highest SUCRA value in both patient-based and lesion-based analyses. In patient-based analysis after 2010, choline PET-CT showed the highest SUCRA value, followed by the CT category, although MIBI SPECT had the highest SUCRA value in analysis before 2009. Conclusions and Relevance The results from this network meta-analysis suggest that choline PET-CT showed the best performance in both patient-based and lesion-based analyses and that choline PET-CT would be the best preoperative imaging modality for localization of pHPT.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, School of Medicine and Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, School of Medicine and Chilgok Hospital, Kyungpook National University, Daegu, South Korea
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Yangsan Hospital, Yangsan, South Korea.,Department of Nuclear Medicine, College of Medicine, Pusan National University, Yangsan, South Korea.,BioMedical Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Gentili F, Guerrini S, Mazzei FG, Monteleone I, Di Meglio N, Sansotta L, Perrella A, Puglisi S, De Filippo M, Gennaro P, Volterrani L, Castagna MG, Dotta F, Mazzei MA. Dual energy CT in gland tumors: a comprehensive narrative review and differential diagnosis. Gland Surg 2020; 9:2269-2282. [PMID: 33447579 DOI: 10.21037/gs-20-543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Dual energy CT (DECT)with image acquisition at two different photon X-ray levels allows the characterization of a specific tissue or material/elements, the extrapolation of virtual unenhanced and monoenergetic images, and the quantification of iodine uptake; such special capabilities make the DECT the perfect technique to support oncological imaging for tumor detection and characterization and treatment monitoring, while concurrently reducing the dose of radiation and iodine and improving the metal artifact reduction. Even though its potential in the field of oncology has not been fully explored yet, DECT is already widely used today thanks to the availability of different CT technologies, such as dual-source, single-source rapid-switching, single-source sequential, single-source twin-beam and dual-layer technologies. Moreover DECT technology represents the future of the imaging innovation and it is subject to ongoing development that increase according its clinical potentiality, in particular in the field of oncology. This review points out recent state-of-the-art in DECT applications in gland tumors, with special focus on its potential uses in the field of oncological imaging of endocrine and exocrine glands.
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Affiliation(s)
- Francesco Gentili
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Susanna Guerrini
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Giuseppe Mazzei
- Unit of Diagnostic Imaging, Department of Radiological Sciences, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Ilaria Monteleone
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Nunzia Di Meglio
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Letizia Sansotta
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Armando Perrella
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Sara Puglisi
- Unit of Radiology, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Massimo De Filippo
- Unit of Radiology, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Paolo Gennaro
- Department of Maxillofacial Surgery, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Volterrani
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Grazia Castagna
- Unit of Endocrinology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Francesco Dotta
- Unit of Diabetology, Department of Medical, Surgical and Neuro Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Maria Antonietta Mazzei
- Unit of Diagnostic Imaging, Department of Medical, Surgical and Neuro Sciences and of Radiological Sciences, University of Siena, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
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12
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Sananmuang T, Agarwal M, Maleki F, Muthukrishnan N, Marquez JC, Chankowsky J, Forghani R. Dual Energy Computed Tomography in Head and Neck Imaging. Neuroimaging Clin N Am 2020; 30:311-323. [DOI: 10.1016/j.nic.2020.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Bunch PM, Randolph GW, Brooks JA, George V, Cannon J, Kelly HR. Parathyroid 4D CT: What the Surgeon Wants to Know. Radiographics 2020; 40:1383-1394. [PMID: 32678698 DOI: 10.1148/rg.2020190190] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Parathyroid four-dimensional (4D) CT is an increasingly used and powerful tool for preoperative localization of abnormal parathyroid tissue in the setting of primary hyperparathyroidism. Accurate and precise localization of a single adenoma facilitates minimally invasive parathyroidectomy, and localization of multiglandular disease aids bilateral neck exploration. However, many radiologists find the interpretation of these examinations to be an intimidating challenge. The authors review parathyroid 4D CT findings of typical and atypical parathyroid lesions and provide illustrative examples. Relevant anatomy, embryology, and operative considerations with which the radiologist should be familiar to provide clinically useful image interpretations are also discussed. The most important 4D CT information to the surgeon includes the number, size, and specific location of candidate parathyroid lesions with respect to relevant surgical landmarks; the radiologist's opinion and confidence level regarding what each candidate lesion represents; and the presence or absence of ectopic or supernumerary parathyroid tissue, concurrent thyroid pathologic conditions, and arterial anomalies associated with a nonrecurrent laryngeal nerve. The authors provide the radiologist with an accessible and practical approach to performing and interpreting parathyroid 4D CT images, detail what the surgeon really wants to know from the radiologist and why, and provide an accompanying structured report outlining the key information to be addressed. By accurately reporting and concisely addressing the key information the surgeon desires from a parathyroid 4D CT examination, the radiologist substantially impacts patient care by enabling the surgeon to develop and execute the best possible operative plan for each patient. ©RSNA, 2020.
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Affiliation(s)
- Paul M Bunch
- From the Departments of Radiology (P.M.B.) and General Surgery (J.C.), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157; Departments of Otolaryngology (G.W.R.) and Radiology (H.R.K.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology Head and Neck Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass (J.A.B.); West Virginia University School of Medicine, Morgantown, WVa (V.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (H.R.K.)
| | - Gregory W Randolph
- From the Departments of Radiology (P.M.B.) and General Surgery (J.C.), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157; Departments of Otolaryngology (G.W.R.) and Radiology (H.R.K.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology Head and Neck Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass (J.A.B.); West Virginia University School of Medicine, Morgantown, WVa (V.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (H.R.K.)
| | - Jennifer A Brooks
- From the Departments of Radiology (P.M.B.) and General Surgery (J.C.), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157; Departments of Otolaryngology (G.W.R.) and Radiology (H.R.K.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology Head and Neck Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass (J.A.B.); West Virginia University School of Medicine, Morgantown, WVa (V.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (H.R.K.)
| | - Valerie George
- From the Departments of Radiology (P.M.B.) and General Surgery (J.C.), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157; Departments of Otolaryngology (G.W.R.) and Radiology (H.R.K.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology Head and Neck Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass (J.A.B.); West Virginia University School of Medicine, Morgantown, WVa (V.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (H.R.K.)
| | - Jennifer Cannon
- From the Departments of Radiology (P.M.B.) and General Surgery (J.C.), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157; Departments of Otolaryngology (G.W.R.) and Radiology (H.R.K.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology Head and Neck Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass (J.A.B.); West Virginia University School of Medicine, Morgantown, WVa (V.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (H.R.K.)
| | - Hillary R Kelly
- From the Departments of Radiology (P.M.B.) and General Surgery (J.C.), Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC 27157; Departments of Otolaryngology (G.W.R.) and Radiology (H.R.K.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Mass; Department of Otolaryngology Head and Neck Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Mass (J.A.B.); West Virginia University School of Medicine, Morgantown, WVa (V.G.); and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (H.R.K.)
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14
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Woisetschläger M, Gimm O, Johansson K, Wallin G, Albert-Garcia I, Spångeus A. Dual energy 4D-CT of parathyroid adenomas not clearly localized by sestamibi scintigraphy and ultrasonography – a retrospective study. Eur J Radiol 2020; 124:108821. [DOI: 10.1016/j.ejrad.2020.108821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 02/06/2023]
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15
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Hiebert J, Hague C, Hou S, Wiseman SM. Dual energy computed tomography should be a first line preoperative localization imaging test for primary hyperparathyroidism patients. Am J Surg 2018; 215:788-792. [DOI: 10.1016/j.amjsurg.2017.11.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
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Pérez-Lara A, Forghani R. Dual-Energy Computed Tomography of the Neck. Neuroimaging Clin N Am 2017; 27:499-522. [DOI: 10.1016/j.nic.2017.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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17
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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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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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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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20
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Detection of parathyroid adenomas using a monophasic dual-energy computed tomography acquisition: diagnostic performance and potential radiation dose reduction. Neuroradiology 2016; 58:1135-1141. [DOI: 10.1007/s00234-016-1736-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/08/2016] [Indexed: 01/14/2023]
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21
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Dual-energy computed tomography: a promising novel preoperative localization study for treatment of primary hyperparathyroidism. Am J Surg 2016; 211:839-45. [DOI: 10.1016/j.amjsurg.2016.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/22/2016] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
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