Four-Dimensional Computed Tomography: Clinical Impact for Patients with Primary Hyperparathyroidism
| Autor: | Julie A Miller, Pramit M. Phal, Damien L Stella, Sharman P. Tan Tanny, Yuan Tian, Meir Lichtenstein, Paul F Einsiedel |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Parathyroidectomy
Adult Male Technetium Tc 99m Sestamibi medicine.medical_specialty Adolescent medicine.medical_treatment Radiation Dosage Sensitivity and Specificity Patient Care Planning 030218 nuclear medicine & medical imaging 03 medical and health sciences Young Adult 0302 clinical medicine Predictive Value of Tests medicine Humans Young adult Four-Dimensional Computed Tomography Aged Retrospective Studies Ultrasonography Aged 80 and over Hyperparathyroidism Parathyroid neoplasm business.industry Retrospective cohort study Middle Aged medicine.disease Hyperparathyroidism Primary Parathyroid Neoplasms Oncology 030220 oncology & carcinogenesis Predictive value of tests Surgery Histopathology Female Radiology business Primary hyperparathyroidism |
| Zdroj: | Annals of surgical oncology. 25(1) |
| ISSN: | 1534-4681 |
| Popis: | In recent years, four-dimensional computed tomography (4DCT) has emerged as a new localization study for primary hyperparathyroidism (pHPT). We aimed to assess the added value of 4DCT in our institution in the first 4 years of use. A retrospective cohort study was conducted from February 2004 to June 2015. Since 2011, patients over 50 years of age without concordant sestamibi-SPECT (SeS) and ultrasound (US) findings underwent 4DCT. Imaging results, surgical findings, histopathology, and postoperative biochemistry were collected. A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22). Parathyroid 4DCT can aid surgical planning in cases without concordant SeS/US findings; however, the introduction of 4DCT as a second-line test did not change our overall cure rate or rate of minimally invasive parathyroidectomy. The role of 4DCT as the primary localization study for pHPT merits further investigation. |
| Databáze: | OpenAIRE |
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