Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Griffith, Brent; Chaudhary, Hamad; Mahmood, G; Carlin, Arthur M.; Peterson, Edward L.; Singer, Michael C.; Patel, Suresh

doi:10.3174/ajnr.a4473

Cited by 26 publications

(19 citation statements)

References 26 publications

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“…However, accuracy of parathyroid imaging reported in the literature varies between 56%‐84% for US and 59%‐93.7% for MIBI . Currently, there is no evidence that additional imaging with CT, MRI or new nuclear scans would result in better localisation . Therefore, single modality imaging has been considered not accurate enough to guide successful MIP and this has led to the concept of “concordant imaging results”, when two or more scans, usually US and MIBI but sometimes CT or MRI, can agree on site and number of abnormal glands.…”

Section: Discussionmentioning

confidence: 99%

Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism

Faheem

Aziz

Morley

et al. 2018

Clinical Endocrinology

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Background/Objective Intraoperative parathyroid hormone (IOPTH) monitoring during surgery for primary hyperparathyroidism (PHPT) could improve cure rate and simplify current care pathways. This study assesses the performance of US, MIBI and IOPTH monitoring and their impact on outcomes and perioperative strategy. Design This is a retrospective study of a prospectively maintained database of patients who underwent parathyroidectomy guided by preoperative US, MIBI and IOPTH monitoring. Test performance (sensitivity, specificity, PPV, NPV, accuracy) and IOPTH added value (percentage of patients in whom test contributed to achieving cure) were calculated. Results A total of 617 patients (median age 59 years, 75% females), 603 (97.7%) of them cured, were included in analysis. Sensitivity of US was higher than MIBI (78.2% vs 70%, P < 0.05), but both were inferior to IOPTH (98.6%, P < 0.05). US and MIBI were more sensitive at detecting single gland disease (SGD) than multigland disease (MGD) (85% vs 55% and 77.5% vs 45.5%, respectively, P < 0.05), while IOPTH performed well in both situations (98.8% vs 96.7%, P > 0.05). In 41 patients with incorrect US predictions, MIBI gave correct result only in 12 (29.3%) cases, while IOPTH gave correct predictions in all but one patient (97.6%). Minimally invasive parathyroidectomy (MIP) was completed in 409 patients, with a similar completion rate regardless whether both or one scan was positive. IOPTH added value was significant in whole cohort (14%) and in subgroups of patients with concordant vs discordant scans, minimally invasive vs conventional surgery, and initial vs reoperative surgery. Conclusions Intraoperative parathyroid hormone monitoring is more accurate at predicting cure than US and MIBI are at identifying abnormal glands in patients undergoing parathyroidectomy for PHPT and significantly contributes to cure rate in range of clinical scenarios. This implies that its routine use could facilitate successful surgery in patients with single positive imaging and increase number of MIPs while maintaining high cure rate.

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Section: Discussionmentioning

confidence: 99%

Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism

Faheem

Aziz

Morley

et al. 2018

Clinical Endocrinology

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“…Performance of 4DCT in most previous studies is based on subjective assessment of lesion enhancement and washout patterns in different phases . Based on the observation that parathyroid adenomas enhance maximally in arterial phase, some studies have suggested dual‐phase CT, to reduce the radiation dose . On the contrary, Bahl et al .…”

Section: Discussionmentioning

confidence: 99%

“…introduced four‐dimensional computed tomography (4DCT) as a localization modality and reported its higher sensitivity (70%) for quadrant‐specific parathyroid lesion localization as compared to that of ultrasonography (USG) (29%) and sestamibi SPECT/CT (33%). Since then, several groups have reported its performance with some modifications in varied cohorts of PHPT patients . However, radiation exposure to neck by 4DCT is relatively high and limits its use as a first‐line investigation modality.…”

Section: Introductionmentioning

confidence: 99%

Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma/hyperplasia in primary hyperparathyroidism

Goroshi

Lila

Jadhav

et al. 2017

Clinical Endocrinology

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“…In 1989, a new approach using the radiopharmaceutical 99m Tc-MIBI was reported for identification and localization of PTG and this imaging method gradually replaced the previous subtraction method based on 201 Tl/ 99 Tc 22 .Several investigators confirmed the use of this technique for the identification of abnormal PTG using either MIBI alone or with subtraction imaging. The sensitivity was in range of 71-93% [23][24][25] . Numerous studies comparing scintigraphy and ultrasonography suggest that both methods have similar sensitivities and specificities in the detection of solitary adenomas with a range of 68%-95% for scintigraphy and a range of 72%-89% for ultrasonography [25][26][27] .…”

Section: Introductionmentioning

confidence: 96%

The accuracy of ultrasonography for detection of enlarged parathyroid glands in patients with different forms of hyperparathyroidism

2020

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Background/Aim:Ultrasonography is a cheap, easily available and convenient method for diagnosis. The aim of this study was: to determine the utility of ultrasonography for preoperative identification and localization of enlarged parathyroid glands (PTG) in patients with different forms of hyperparathyroidism (HPT); to examine the frequency of PTG detection in patients previously non-suspected for HPT but having symptoms relevant to the disease; to determine sensitivity and positive predictive value (PPV) of ultrasonography for identification of PTG in HPT and to compare them with scintigraphy. Methods: This investigation was designed as a retrospectiveprospective study. The total number of patients undergoing ultrasonography prior to surgery was 179 and the number of those subjected to scintigraphy, mostly by the 201 Tl/ 99m Tc method, was 112. The patients (52 male; 128 female) were divided into the following four groups: group Apatients with primary (p)HPT (n=78); group Bpatients with secondary (s)HPT (n=47); group Cpatients with tertiary (t)HPT (n=13); group Dpatients with unrecognized (u)HPT, but with anamnestic data implying the disease (n=42). High resolution ultrasonography was performed by a single experienced observer. Diagnosis of HPT was based on characteristic clinical and biochemical parameters. Final proof of HPT diagnosis was surgery followed by histopathological examination. Results: Ultrasonography detected enlarged PTG in 93.85% of total patients, whereas scintigraphy uncovered 75.89% positive cases (p<0.05). The total number of positive PTG detected by ultrasonography was 211 versus 225 detected by surgery (sensitivity-95.9%; PPV-99.4%). Histopathology confirmed the predominance of adenoma in A and D groups in comparison with B group of patients having PTG hyperplasia.Group C was characterized by the presence of adenomas in hyperplastic PTG. The mean size of PTG measured by ultrasonography was 17.59 ± 8.0mm (n=164) versus18.36 ± 8.54mm (n=179),measured after surgery. Ultrasonography proved itself as an accurate technique in all HPT groups, regarding its high sensitivity (range 93.6-100%) and PPV (95.6-100%). In contrast, scintigraphy was shown to be less reliable, especially in sPTH group (sensitivity: 51.7%; PPV: 78.4%). Conclusion: Ultrasonography is more sensitive and accurate method for pre-opreative localization of PTG in comparison with 201 Tl/ 99m Tc scintigraphy. It can be also efficiently used for detection of PTG and diagnosis of HPT in patients previously not suspected for this disease.

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Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Cited by 26 publications

References 26 publications

Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism

Impact of intraoperative parathyroid hormone monitoring on the management of patients with primary hyperparathyroidism

Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma/hyperplasia in primary hyperparathyroidism

The accuracy of ultrasonography for detection of enlarged parathyroid glands in patients with different forms of hyperparathyroidism

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