4D-CT for Preoperative Localization of Abnormal Parathyroid Glands in Patients with Hyperparathyroidism: Accuracy and Ability to Stratify Patients by Unilateral versus Bilateral Disease in Surgery-Naïve and Re-Exploration Patients

Abstract

BACKGROUND AND PURPOSE: 4D-CT is an emerging technique that uses high-resolution images, multiplanar reformats, and perfusion characteristics to identify abnormal parathyroid glands in patients with hyperparathyroidism. This study evaluates the accuracy of 4D-CT for localization and lateralization of abnormal parathyroid glands in preoperative planning for minimally invasive parathyroidectomy vs bilateral neck exploration at a tertiary referral center.

Preoperative Localization of Abnormal Parathyroid Glands

“…92,93 CT has shorter examination times than 99m Tc-sestamibi scintigraphy and comparable overall cost, while the relatively high radiation exposure of CT can be kept to a minimum using accurate acquisition protocols. For these reasons and based on local availability and logistical conditions, some groups propose CT alone or combined with US as an alternative to 99m Tc-sestamibi scintigraphy as the first step for preoperative localization of parathyroid lesions.…”

Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: How many phases do we really need?

“…The change from a 4-phase to a 3-phase CT protocol allowed reduction in the effective radiation dose of a multiphase CT to 21 mSv. 14 We hypothesized that elimination of the precontrast and delayed phases from the typical 4-phase acquisition would not result in diminished diagnostic accuracy while halving the radiation exposure.…”

Dynamic 4D MRI for Characterization of Parathyroid Adenomas: Multiparametric Analysis

“…This discussion is beyond the scope of this article; however, effective radiation doses ranging from 5.56 to 10.4 mSv [4][5][6] have been reported, depending on the acquisition scheme used. Our second finding is that the described MR perfusion technique can successfully exploit the hypervascular nature of PTAs, a feature that can be used to differentiate them from PTA candidates such as subjacent cervical lymph node and thyroid tissue.…”

“…4D CT has shown superior accuracy compared with scintigraphy, 3 though the radiation dose remains as high as 5.56 -10.4 mSv. [4][5][6] MR imaging is an attractive alternative to both scintigraphy and 4D CT due to the lack of radiation and has been used for the evaluation of PTAs with some success, [7][8][9] though not with the same effectiveness as 4D CT. Traditional technical limitations to localizing PTAs with MR imaging have recently been addressed with modern MR imaging technology.…”