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

Nael, Kambiz; Hur, Jin; Bauer, Adam; Khan, Rihan; Sepahdari, Ali R.; Inampudi, R.; Guerrero, Marlon A.

doi:10.3174/ajnr.a4425

Cited by 68 publications

(37 citation statements)

References 25 publications

(22 reference statements)

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“…Because of the lack of adipose tissue in parathyroid adenomas, high signal intensity on T2-weighted images is seen typically at MR imaging, which enables detection of adenomas (27). Because of advances in technology, its accuracy has increased even further with the use of dynamic contrast materialenhanced imaging (16). In our study, however, use of MR imaging alone was substantially less successful than use of the combination of PET and MR imaging.…”

Section: Discussionmentioning

confidence: 65%

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

et al. 2017

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Purpose To investigate the performance of flourine 18 (F) fluorocholine (FCH) positron emission tomography (PET)/magnetic resonance (MR) imaging in patients with hyperparathyroidism and nonlocalized disease who have negative or inconclusive results at ultrasonography (US) and technetium 99m (Tc) sestamibi scintigraphy. Materials and Methods This study was approved by the institutional review board. Between May and December 2015, 10 patients (mean age, 70.4 years; range, 58-82 years) with biochemical primary hyperparathyroidism and inconclusive results at US and Tc sestamibi scintigraphy were prospectively enrolled. All patients gave informed consent. Directly after administration of 3 MBq/kg of FCH, PET imaging was performed, followed by T1- and T2-weighted MR imaging before and after gadolinium enhancement. Intraoperative localization and histologic results were the reference standard for calculating sensitivity and positive predictive value. The Wilcoxon rank test was used to calculate the mean difference in maximum standardized uptake value (SUV) between abnormal parathyroid uptake and physiologic thyroid uptake. The Wilcoxon rank-sum test was performed. Results MR imaging alone showed true-positive lesions in five patients and a false-positive lesion in one patient. FCH PET/MR imaging allowed correct localization of nine of 10 adenomas (90% sensitivity), without any false-positive results (100% positive predictive value). One patient had four-gland hyperplasia, of which three hyperplastic glands were not localized. The median SUV of the nine preoperatively identified adenomas was 4.9 (interquartile range, 2.45-7.35), which was significantly higher than the SUV, 2.7 (interquartile range, 1.6-3.8), of the thyroid (P = .008). Conclusion FCH PET/MR imaging allowed localization of adenomas with high accuracy when conventional imaging results were inconclusive and provided detailed anatomic information. More patients must be examined to confirm our initial results, and the accuracy of FCH PET/MR imaging for localization of glands in patients with four-gland hyperplasia remains to be investigated. RSNA, 2017.

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Section: Discussionmentioning

confidence: 65%

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

et al. 2017

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“…[41][42][43] Dynamic contrast-enhanced MRI may also be used to localize parathyroid adenomas, taking advantage of the hypervascular nature and differential contrast washout from parathyroid adenomas compared with lymph nodes and thyroid tissue. [44][45][46]…”

Section: Ct and Mrimentioning

confidence: 99%

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

et al. 2018

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Background Revision parathyroid is challenging due to possible diagnostic uncertainty as well as the technical challenges it can present. Methods A multidisciplinary panel of distinguished experts from the American Head and Neck Society (AHNS) Endocrine Section, the British Association of Endocrine and Thyroid Surgeons (BAETS), and other invited experts have reviewed this topic with the purpose of making recommendations based on current best evidence. The literature was also reviewed on May 12, 2017. PubMed (1946‐2017), Cochrane SR (2005‐2017), CT databases (1997‐2017), and Web of Science (1945‐2017) were searched with the following strategy: revision and reoperative parathyroidectomy to ensure completeness. Results Guideline recommendations were made in 3 domains: preoperative evaluation, surgical management, and alternatives to surgery. Eleven guideline recommendations are proposed. Conclusion Reoperative parathyroid surgery is best avoided if possible. Our literature search and subsequent recommendations found that these cases are best managed by experienced surgeons using precision preoperative localization, intraoperative parathyroid hormone (PTH), and the team approach.

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“…This exploits similar principles to 4D-CT and the enhancement and wash out characteristics of parathyroid adenomata (though lipidrich adenomata have been described to demonstrate more delayed wash out relative to the more cellular lesions). A retrospective study by Nael et al [8] has reported a high (96%) diagnostic accuracy in adenoma The images demonstrate an extra-thyroid, right-sided septated cystic-solid lesion within level VI of the neck and the arrow points to non-dependent, subtle intralesional soft tissue. There is effacement of the right pyriform fossa more superiorly.…”

Section: Cross-sectional Imagingmentioning

confidence: 99%

Atypical presentations of parathyroid gland pathology: A pictorial review

Kowa

Richards

Waterhouse

et al. 2019

European Journal of Radiology Open

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

Cited by 68 publications

References 25 publications

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Atypical presentations of parathyroid gland pathology: A pictorial review

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

Cited by 68 publications

References 25 publications

18F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

18F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons

Atypical presentations of parathyroid gland pathology: A pictorial review

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¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study