Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy

Hoang, Jenny K.; Reiman, Robert E.; Nguyen, Giao; Januzis, Natalie; Chin, Bennett B.; Lowry, Carolyn; Yoshizumi, Terry T.

doi:10.2214/ajr.14.13278

Cited by 70 publications

(69 citation statements)

References 19 publications

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“…Although there are no good data on cancer incidence after low radiation exposure, conservatively, the net radiation exposure increases a patient's annual cancer risk by 0.019% and lifetime cancer risk by 0.52% compared with the baseline cancer incidence. 25,26 We believe that this is a favorable risk/benefit ratio given the very small cancer risk balanced against the serious health consequences of persistent hyperparathyroidism, especially in an older patient population.…”

Section: Discussionmentioning

confidence: 99%

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Vu¹,

Schellingerhout²,

Guha-Thakurta³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Minimally invasive parathyroid surgery relies critically on image guidance, but data comparing the efficacy of various imaging modalities are scarce. Our aim was to perform a blinded comparison of the localizing capability of technetium Tc99m sestamibi SPECT, multiphase multidetector 4D CT, and the combination of these 2 modalities (technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT). MATERIALS AND METHODS:We reviewed the records of 31 (6 men, 25 women; median age, 56 years) consecutive patients diagnosed with biochemically confirmed primary hyperparathyroidism between November 2009 and March 2010 who underwent preoperative technetium Tc99m sestamibi SPECT and multiphase multidetector 4D CT performed on the same scanner with pathologic confirmation by resection of a single parathyroid adenoma. Accuracy was determined separately for localization to the correct side and quadrant using surgical localization as the standard of reference. RESULTS:Surgical resection identified 14 left and 17 right parathyroid adenomas and 2 left inferior, 12 left superior, 11 right inferior, and 6 right superior parathyroid adenomas. For left/right localization, technetium Tc99m sestamibi SPECT achieved an accuracy of 93.5% (29 of 31), multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31), and technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT achieved 96.8% accuracy (30 of 31). For quadrant localization, technetium Tc99m sestamibi SPECT accuracy was 67.7% (21 of 31), multiphase multidetector 4D CT accuracy was 87.1% (27 of 31), and technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT accuracy was 93.5% (29 of 31). Reader diagnostic confidence was consistently ranked lowest for technetium Tc99m sestamibi SPECT and highest for technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT. CONCLUSIONS:For left/right localization of parathyroid adenomas, all modalities performed equivalently. For quadrant localization, technetium Tc99m sestamibi SPECT ϩ multiphase multidetector 4D CT is superior to technetium Tc99m sestamibi SPECT. ABBREVIATIONS:4DCT ϭ multiphase multidetector 4D CT; MIBI ϭ technetium Tc99m sestamibi

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Section: Discussionmentioning

confidence: 99%

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Vu¹,

Schellingerhout²,

Guha-Thakurta³

et al. 2018

AJNR Am J Neuroradiol

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“…the basis of a prior phantom study that measured organ doses with dosimeters, scanning a 73-kg patient with this protocol would result in dose length product of 1928 mGy · cm and calculated effective dose from organ doses of 28 mSv (9).…”

Section: Implications For Patient Carementioning

confidence: 99%

Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol

et al. 2015

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“…An alternative approach is four‐dimensional CT (4DCT): three‐dimensional CT with the added dimension of changes in contrast perfusion over time. 4DCT has been shown to be considerably better than both ultrasound imaging and MIBI/SPECT–CT in localizing parathyroid disease in patients with recurrent or persistent PHPT after previous surgery, at the expense of a considerably increased dose of radiation.…”

Section: Introductionmentioning

confidence: 99%

“…An alternative approach is four-dimensional CT (4DCT): three-dimensional CT with the added dimension of changes in contrast perfusion over time 22 . 4DCT has been shown to be considerably better than both ultrasound imaging and MIBI/SPECT-CT in localizing parathyroid disease in patients with recurrent or persistent PHPT after previous surgery 23 -25 , at the expense of a considerably increased dose of radiation 26 . Table 1 Overview of patient demographics, preoperative blood tests and imaging studies, operative approach and outcomes When ultrasonography, MIBI/SPECT-CT and 4DCT findings are inconclusive, interventional radiology techniques such as selective venous sampling, ideally with angiography, may be considered 27 -31 .…”

Section: Introductionmentioning

confidence: 99%

Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

et al. 2019

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BackgroundPrimary hyperparathyroidism (PHPT), caused by an ectopic mediastinal parathyroid adenoma, is uncommon. In the past, when the adenoma was not accessible from the neck, median sternotomy was advocated for safe and successful parathyroidectomy. Video‐assisted thoracoscopic surgical (VATS) parathyroidectomy represents a modern alternative approach to this problem.MethodsInformation on patients undergoing VATS was obtained from a specific database, including clinical presentation, biochemistry, preoperative imaging, surgical approach and patient outcomes. A comprehensive literature review was undertaken to draw comparisons with other publications.ResultsOver a 2‐year period, nine patients underwent VATS parathyroidectomy for sporadic PHPT. Five patients had persistent PHPT following previous unsuccessful parathyroidectomy via cervicotomy, and four had had no previous parathyroid surgery. The median duration of surgery was 90 (range 60–160) min. Eight patients were cured biochemically, with no major complications. One patient required conversion to a median sternotomy for removal of a thymoma that had resulted in false‐positive preoperative imaging.ConclusionWith appropriate preoperative imaging, multidisciplinary input and expertise, VATS parathyroidectomy is an effective, safe and well tolerated approach to ectopic mediastinal parathyroid adenoma.

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Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy

Abstract: The ED of 4D CT is more than double that of scintigraphy, but both studies cause negligible increases in lifetime risk of cancer. Clinicians should not allow concern for radiation-induced cancer to influence decisions regarding workup in older patients.

Cited by 70 publications

References 19 publications

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Solitary Parathyroid Adenoma Localization in Technetium Tc99m Sestamibi SPECT and Multiphase Multidetector 4D CT

Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol

Video‐assisted thoracoscopic surgery for ectopic mediastinal parathyroid adenoma

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