Outcomes and Economic Analysis of Routine Preoperative 4-Dimensional CT for Surgical Intervention in de novo Primary Hyperparathyroidism: Does Clinical Benefit Justify the Cost?

The utility of 4-dimensional computed tomography for preoperative localization of primary hyperparathyroidism in patients not localized by sestamibi or ultrasonography

“…8,15 Caution has been raised regarding radiation exposure in the use of 4D CT, which calls its use into question as a primary localization study. [16][17][18][19]20,21 4D CT appears to have a role in preoperative localization in patients who fail to localize by US or STS or in select patients as a primary localization study.…”

Better performance of four‐dimension computed tomography as a localization procedure in normocalcemic primary hyperparathyroidism

“…It should also be taken into account the costs of preoperative localization methods, although recent studies have already shown that the use of 4D CT allows more frequently the performance of minimally invasive parathyroidectomies with shorter hospital stay and consequently lower cost. [30][31][32] Another important factor is the impossibility to perform this localization method in patients with previous history of allergy to iodinated contrast agents and in patients with renal insufficiency, as well as the exposure to radiation (greater than with regular CT), which should, therefore limit its use as an initial localization procedure for adults or a second-line procedure for children and young adults. 20,22,30,33 Finally, the poor agreement between the three procedures suggests that they are complementary as preoperative parathyroid localization techniques.…”

Four‐dimensional computed tomography (4DCT): A review of the current status and applications

“…In a study assessing the economic benefits of 4DCT in the routine preoperative assessment for primary hyperparathyroidism, although economic benefit was not found, non‐economic benefits were gained, including shorter hospital stays and improved rates of minimally invasive parathyroidectomy . Four‐gland bilateral exploration is usually required when the traditional modalities – neck ultrasound and sestamibi scanning – fail or are discordant …”