Four-Dimensional Computed Tomography for Parathyroid Adenoma Localization: A Pre-Operative Imaging Protocol.
| Autor: | Bellamkonda N; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA., Highland J; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA., McCrary HC; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA., Slattery L; Department of Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA., King B; School of Medicine, University of Utah, Salt Lake City, UT, USA., Teames C; School of Medicine, University of Utah, Salt Lake City, UT, USA., LeBaron K; School of Medicine, University of Utah, Salt Lake City, UT, USA., Wiggins RH; Department of Radiology, School of Medicine, University of Utah, Salt Lake City, UT, USA., Abraham D; Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA., Hunt JP; Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Utah, Salt Lake City, UT, USA. |
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| Jazyk: | angličtina |
| Zdroj: | The Annals of otology, rhinology, and laryngology [Ann Otol Rhinol Laryngol] 2024 Apr; Vol. 133 (4), pp. 441-448. Date of Electronic Publication: 2024 Feb 07. |
| DOI: | 10.1177/00034894241230353 |
| Abstrakt: | Objective: Primary hyperparathyroidism (PHPT) affects approximately 0.86% of the population, with surgical resection as the treatment of choice. A 4D computed tomography (CT) is a highly effective tool in localizing parathyroid adenomas; however, there is currently no defined role for 4D CT when stratified against ultrasonography (USG) and nuclear medicine Technetium Sestamibi SPECT/CT (SES) imaging. Study Design: Retrospective Study. Setting: University Hospital. Methods: All patients who underwent parathyroidectomy for PHPT between 2014 and 2019 at a single institution were reviewed. Patients who had a 4D CT were included. We compared outcomes of 4D CT as a second line imaging modality to those of USG and SES as first line modalities. An imaging algorithm was proposed based on these findings. Results: There were 84 patients identified who had a 4D CT after unsuccessful first line imaging. A 4D CT localized parathyroid adenoma to the correct quadrant in 64% of cases, and to the correct laterality in 75% of cases. Obese patients had significantly lower rates of adenoma localization with USG (33.4%), compared to non-obese patients (67.5%; P = .006). In determining multigland disease the sensitivity of 4D CT was 86%, while the specificity was 87%. Conclusions: A 4D CT has impressive rates of accurate localization of parathyroid adenomas; however due to the radiation exposure involved, it should remain a second line imaging modality. PHPT patients should first be evaluated with USG, with 4D CT used if this is unsuccessful and patients are greater than 40 years old, have a high BMI, or are having revision surgery. Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. |
| Databáze: | MEDLINE |
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