Localization of Parathyroid Adenoma by Computed Tomography

Ovenfors, Carl-Olof; Stark, David D.; Moss, Albert A.; Goldberg, Henry I.; Clark, Orlo H.; Galante, Maurice

doi:10.1097/00004728-198212000-00007

Cited by 13 publications

(4 citation statements)

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“…Previous studies have suggested that ultrasonog-raphy [14-16], CT scanning [6,17,18], and selective venous sampling for PTH are helpful for patients with hyperparathyroidism who have previously had failed parathyroid operations [13,19,20].…”

Section: Discussionmentioning

confidence: 99%

Localization procedures in patients requiring reoperation for hyperparathyroidism

et al. 1984

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Numerous techniques have been described for the preoperative localization of hyperfunctioning parathyroid glands. During the past 2 years, 18 patients have had operations for persistent (14) or recurrent (4) hyperparathyroidism. One or more hyperfunctioning parathyroid glands were identified at operation in all but 1 patient and all but 2 patients became normocalcemic. Eighteen patients had ultrasonography, 17 patients had computed tomography (CT) scanning, and 13 patients had selective venous sampling (SVS) for parathyroid hormone (PTH) assay. These studies correctly identified the lesion(s) in 9 (50%), 8 (47%), and 9 (69%) of the patients, respectively. In 3 patients, probable parathyroid tumors were identified by ultrasonography and confirmed by aspiration biopsy cytology under ultrasonic guidance. All had parathyroid tumors confirmed at operation. The smallest tumor localized by ultrasonography was 0.6×0.6×0.6 cm and by CT scanning was 0.9×0.9×0.8 cm. There was 1 false‐positive CT scan and 1 false‐positive SVS. In the 2 patients who failed to become normocalcemic no localization study was positive. One of these patients subsequently had a 0.6×0.6×0.5 cm mediastinal adenoma localized by CT scan, nuclear magnetic resonance, and SVS. The tumor was removed via median sternotomy and the patient is now normocalcemic. Digital angiography has recently been helpful for “mapping out” the venous pattern for venous sampling for PTH. Ultrasonography and CT scanning complemented each other, since one or the other of these studies was positive in 15 patients, yet only 2 patients had both a positive ultrasound and CT scan. When any 2 localizing tests suggested the same site for the parathyroid lesion, the tumor was found in all cases. One patient developed post‐pericardotomy syndrome after a medium sternotomy, but there were no other complications. Localization procedures expedite surgical treatment, decrease morbidity, and are strongly recommended in patients requiring reoperation for hyperparathyroidism.

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Section: Discussionmentioning

confidence: 99%

Localization procedures in patients requiring reoperation for hyperparathyroidism

et al. 1984

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“…A wide variety of imaging techniques has been proposed to localize parathyroid adenomata and hyperplasia. Currently, vigorous debate centers on techniques that are readily available, noninvasive, and hold promise as practical methods for parathyroid localization: thallium-technetium scintigraphy (TTS) [5][6][7][8][9][10][11][12][13], computed tomography (CT) [14][15][16][17][18][19][20][21][22][23][24], and sonography (US) [25][26][27][28][29][30][31][32][33][34][35]. We compared these 3 imaging modalities prospectively, using as the standard for comparison the surgical, pathologic, and clinical findings.…”

mentioning

confidence: 99%

Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors

et al. 1986

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Controversy exists concerning the advantages and appropriateness of current imaging modalities of the localization of parathyroid tumors. We conducted a prospective, blinded study to compare the efficacy of 3 different imaging modalities in 40 patients with primary hyperparathyroidism (HPT). Patients with HPT were examined preoperatively by computer‐assisted thallium‐201/technetium‐99m scintigraphy (TTS), high‐resolution (GE 9800) computed tomography (CT), and high‐resolution (7.5 MHz) real‐time sonography (US). Each study was performed and interpreted independently. These patients then had a neck exploration and parathyroidectomy which allowed for clinical correlation of pathologic findings with the imaging results. Overall sensitivities of the 3 imaging modalities were TTS‐72%, CT‐72%, and US‐57%, with specificities of TTS‐93%, CT‐92%, and US‐96%. For lesions located below the thyroid (thymic tongue and mediastinum), sensitivities were TTS‐86%, CT‐29%, and US‐20%, all with specificities of 100%. In those HPT patients presenting with prior failed neck explorations, parathyroid tumors were detected with sensitivities of TTS‐88%, CT‐57%, and US‐67%, with specificities of 100%, 71%, and 100%, respectively. TTS with subsequent CT appears to be an optimal imaging strategy for HPT patients with prior failed neck explorations or suspected lesions below the thyroid. Since surgeons experienced in parathyroid surgery have a cure rate of 93% or greater in HPT patients without prior neck exploration, these imaging modalities may not be cost‐effective and thus not indicated for these patients.

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“…Computed tomography. The accuracy of computed tomography (CT) in detecting parathyroid adenomas is primarily dependent on the size of the tumor [72,73]. Contrast enhancement appears to occur in 25% of parathyroid tumors, and large tumors are more likely to enhance than are small tumors [74].…”

Section: Imaging Of Hyperparathyroidismmentioning

confidence: 99%

Diagnostic advances in APUDomas and other endocrine tumors: Imaging and localization

McLeod

Few

Shapiro

1993

Seminars in Surgical Oncology

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The different diagnostic imaging modalities available for determining the location of the various APUDomas are discussed with reference to their advantages and disadvantages. The ability to image these lesions, and to be confident in their role in the underlying pathophysiology, and clinical neuroendocrine syndrome causing symptomatology and illness, has proved to be the key to successful treatment. In many instances it is not the diagnosis that is in question, but it is the extent of disease, the location of the lesion, or whether the anatomical abnormality under study is responsible for the complicating symptoms being considered, that are the crucial questions. The ability to locate APUDomas by a variety of direct and indirect imaging or regionalizing modalities, represent a magnificent advance in the management of these tumors. It should, however, be kept in mind that no one modality or diagnostic method can uniformly be relied upon. It is evident that a multimodal, interactive medical team approach is essential to the successful overall management of patients afflicted with these fascinating tumors.

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Localization of Parathyroid Adenoma by Computed Tomography

Cited by 13 publications

References 0 publications

Localization procedures in patients requiring reoperation for hyperparathyroidism

Localization procedures in patients requiring reoperation for hyperparathyroidism

Prospective comparison of radionuclide, computed tomographic, and sonographic localization of parathyroid tumors

Diagnostic advances in APUDomas and other endocrine tumors: Imaging and localization

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