Dual-energy computed tomography is a superior diagnostic performance for locating parathyroid tumors

Abstract

Purpose To analyze the accuracy of three imaging methods for locating parathyroid tumors preoperatively in patients with primary hyperthyroidism (PHPT). Methods We retrospectively analyzed the accuracy of dual-energy computed tomography (DECT), cervical ultrasound (US), and 99m-technetium-labeled methoxyisobutylisonitrile single-photon emission computed tomography/computed tomography (99mTc-MIBI SPECT/CT) for the preoperative localization of abnormal parathyroid glands in 277 patients, who underwent parathyroidectomy from February 2017 to March 2023 in our department. We compared the diagnostic efficiency of the three imaging methods for localization of abnormal parathyroid glands, including those with single parathyroid adenomas or carcinomas, double adenomas (DAs), multiple gland hyperplasia disease (MGHD), and ectopic parathyroid tumors. Results A total of 283 pathological parathyroid glands were found in the 277 PHPT patients. The DECT sensitivity of 93.3% was superior to that of US at 92.2% and 99mTc-MIBI SPECT/CT at 75.6%. Ectopic locations were diagnosed by DECT in 12/13 (92.3%) patients by 99mTc-MIBI SPECT/CT in 11/13 (84.6%) patients and by US in 8/13 (61.5%) patients. The diagnostic efficiency was 98.59% for the combination of US and DECT, 97.17% for MIBI and DECT, and 95.76% for US and 99mTc-MIBI SPECT/CT. The diagnostic efficiency of the combination of all three methods for identifying pathological parathyroid glands was 99.29%. Conclusion DECT has a higher diagnostic accuracy rate than US and 99mTc-MIBI SPECT/CT for the preoperative localization of abnormal parathyroid glands, and it has advantages for the localization of ectopic parathyroid glands. DECT shows promise as a first-line preoperative localization imaging method for PHPT patients and may lead to significantly improved preoperative localization of pathological parathyroid glands when combined with US and 99mTc-MIBI SPECT/CT.