Role of four-dimensional computer tomography (4D-CT) in non-localising and discordant first-line imaging in primary hyperparathyroidism.
| Autor: | Sayed S; CancerCare Manitoba, Winnipeg, Canada., Das A; Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India., Turner B; CancerCare Manitoba, Winnipeg, Canada., Wadhwa VS; Cedars Sinai Medical Center, Los Angeles, USA., Pathak KA; CancerCare Manitoba, Winnipeg, Canada. |
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| Jazyk: | angličtina |
| Zdroj: | Annals of the Royal College of Surgeons of England [Ann R Coll Surg Engl] 2023 Nov; Vol. 105 (8), pp. 739-746. Date of Electronic Publication: 2023 Feb 07. |
| DOI: | 10.1308/rcsann.2022.0126 |
| Abstrakt: | 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 99m Tc-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 99m Tc-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 99m Tc-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. |
| Databáze: | MEDLINE |
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