The Role of Computed Tomography for Localization of Parathyroid Adenomas

Zald, Philip B.; Hamilton, Bronwyn E.; Larsen, Michael L.; Cohen, James I.

doi:10.1097/mlg.0b013e318177098c

Cited by 34 publications

(24 citation statements)

References 14 publications

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“…2,3 Moreover, 4-dimensional CT is used in special cases. 4,13,24 Our data provide evidence that MIBI-SPECT or CT alone is not able to accurately localize abnormal glands. CT-MIBI image fusion, however, appears to be superior to CT or MIBI-SPECT alone.…”

Section: Discussionmentioning

confidence: 83%

Virtual Neck Exploration

Prommegger¹,

Wimmer²,

Profanter³

et al. 2009

Annals of Surgery

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Section: Discussionmentioning

confidence: 83%

Virtual Neck Exploration

Prommegger¹,

Wimmer²,

Profanter³

et al. 2009

Annals of Surgery

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“…Recent developments of equipment, algorithms and protocols have increased the sensitivity, but it remains lower than both MIBI and US. One study concluded that when MIBI and US are unavailable or indeterminate, CT, with more or less conventional 3-mm slices and contrast enhancement, may be used to localise the correct quadrant of the neck with a sensitivity of 87% and a PPV of 69% [68]. Another prospective study compared helical CT and MIBI, which presented high sensitivity and PPV for CT, but still concluded that there is no need for more than one modality for preoperative localisation [69].…”

Section: Computer Tomographymentioning

confidence: 96%

Imaging for primary hyperparathyroidism—an evidence-based analysis

Mihai

Simon²,

Hellman

2009

Langenbecks Arch Surg

148

115

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We found evidence at level III leading to recommendations at grade B, that sestamibi scintigraphy is a recommended first test, but that US by an experienced investigator may be an alternative. MIP may be performed when both tests are concordant, and in case of only one test being positive, unilateral exploration and use of intraoperative PTH measurements are recommended. Bilateral neck exploration is used when both tests are negative. For reoperative procedures, repeat investigations are recommended, but also to use US-guided fine needle aspiration and PTH measurements as well as venous sampling. However, for reoperative procedures, the level of evidence is weaker-level IV, but recommendations still at grade B.

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“…However, in other study Sestamibi scan correctly localized the parathyroid adenoma in only 58% of the patients [24]. So, when first line studies are indeterminate the positive predictive value of CT for localization of parathyroid adenoma to the correct side and quadrant of the neck has been reported to 87 and 69%, respectively [25]. In our experience, an endoscopic parathyroidectomy is more challenging, but still viable in a patient who has nonlocalizing imaging studies, but a favorable anatomy: for the 9 patients without preoperative detection, 5 had a successful endoscopic procedure.…”

Section: Discussionmentioning

confidence: 88%

“…In our experience, an endoscopic parathyroidectomy is more challenging, but still viable in a patient who has nonlocalizing imaging studies, but a favorable anatomy: for the 9 patients without preoperative detection, 5 had a successful endoscopic procedure. Misinterpretation of multiglandular diseases or small parathyroid size limits the detection of parathyroid gland by imaging preoperative techniques [23][24][25]. One of the advantages of the endoscopic approach includes improved magnification and intense illumination.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic parathyroidectomy in primary hyperparathyroidism

Prades

Asanau

Timoshenko

et al. 2010

Eur Arch Otorhinolaryngol

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During the past decade, endoscopic video-assisted parathyroidectomy (EP) for primary hyper parathyroidism (PHPT) has gained wider acceptance. The endoscopic gasless procedure described by P. Miccoli (1997-1998) offers an attractive technique. A routine preoperative localization study was performed with both ultrasonography and 99m TC-Sestamibi scintigraphy for each patient with sporadic PHPT. The criteria to select patients eligible for EP included absence of significant nodular goiter, a previous neck surgery, a need for concomitant thyroidectomy, a significant obesity, and multiple enlarged parathyroid glands. The surgical outcome and the use of preoperative localization together with the operative strategy were evaluated. From 2005 to 2009, 59 out of 75 patients (78%) were potentially candidates for this approach. An enlarged parathyroid gland was located by both types of imaging for 34 patients (57%) and by 99 m Tc-Sestamibi scintigraphy for 46 patients (77%). Conversion was required in 11 cases (18%). Nine patients had a negative preoperative imaging study and five underwent a successful EP. The operating time ranged from 35 to 120 min (median 45 min). Usually patients were discharged home at 48 h. There were no cases of permanent hypocalcemia or recurrent laryngeal nerve palsy. Postoperative review showed that all calcium and parathyroid hormone levels remained normal at 3 months except for 1 patient with a double adenoma. EP is a quick, safe, and effective procedure in a selected group of patients. Our results show that this technique can be easily introduced into a general head and neck practice.

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The Role of Computed Tomography for Localization of Parathyroid Adenomas

Abstract: When first-line localization studies are indeterminate in patients with primary hyperparathyroidism, CT is a valuable, rapid, and widely available imaging modality that can be used to localize PA.

Cited by 34 publications

References 14 publications

Virtual Neck Exploration

Virtual Neck Exploration

Imaging for primary hyperparathyroidism—an evidence-based analysis

Endoscopic parathyroidectomy in primary hyperparathyroidism

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