4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease

Hamidi, Moska; Sullivan, Michael; Hunter, George J.; Hamberg, Leena M.; Cho, Nancy L.; Gawande, Atul A.; Doherty, Gerard M.; Moore, Francis D.; Nehs, Matthew A.

doi:10.1245/s10434-018-6367-z

Cited by 43 publications

(34 citation statements)

References 28 publications

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“…The utility of this modality arises from the washout time of the contrast agent in lymph nodes compared to parathyroid glands. [18][19][20][21] However, on average, SPECT/CT is a lower radiation dose (7 mSv) compared to 4D-CT (10.8 mSv). 22,23 Other groups have attempted to use MRI with limited success.…”

Section: Introductionmentioning

confidence: 99%

Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism

et al. 2019

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Localization of parathyroid adenomas for treatment of primary hyperparathyroidism can be challenging. This retrospective study compared single-photon emission computed tomography/computed tomography (SPECT/CT), 4D-CT, and US studies in detection of adenomas prior to surgery. A retrospective chart review was performed on all consecutive patients with parathyroid adenoma presenting to an urban tertiary care medical center. A total of 58 patients (45 female, 13 male) underwent surgery for parathyroid adenoma. Patients aged 28 to 80 years (mean: 58.8) with parathyroid hormone levels ranging from 42 to 424 pg/mL (mean: 168). All patients underwent preoperative SPECT/CT with 20 mCi technetium-99m MIBI (99m Tc-MIBI). Fifty-three patients had additional US imaging and 14 patients had 4D-CT scans. Additionally, 34 patients had injection of 20 mCi 99m Tc-MIBI on the day of surgery. Pathological correlation was performed. Comparing SPECT/CT versus 4D-CT resulted in sensitivity (77% vs 80%), specificity (71% vs 75%), and accuracy (77% vs 79%). Ultrasound was less sensitive with similar specificity (44%, 86%, respectively). Combination of SPECT/CT and 4D-CT increased sensitivity to 88%, specificity to 100%, and accuracy to 89%. Combining SPECT/ CT with US resulted in sensitivity of 85%, specificity of 83%, and accuracy of 85%. Intraoperative localization substantially improved in patients who received preoperative injections. The SPECT/CT remains the best imaging modality for preoperative localization of parathyroid adenomas with high sensitivity. Combining SPECT/CT with US resulted in increased sensitivity and accuracy. For suspicion of ectopic cases or suspicion of unidentifiable adenoma with negative scintigraphy, addition of 4D-CT is recommended. Intraoperative localization and adjunctive imaging may improve surgical management of patients with hyperparathyroidism.

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Section: Introductionmentioning

confidence: 99%

Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism

et al. 2019

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“…As a first-line study in de novo or uncomplicated patients with PHPT, 4DCT has sensitivity to localization between 62 and 92% and a PPV between 88 and 94% [28]. In the reoperative setting, 4DCT has sensitivity for localization as high as 93% and sensitivity for lateralization as high as 97% [28,37,60,[63][64][65]. However, this modality exhibits variable accuracy in patients with multigland disease ( Figure 6).…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

“…Although 4DCT can correctly predict multigland disease in 80 to 90% of patients with surgically proven multigland disease (in studies that pooled both de novo and reoperative patients) [60,65], its sensitivity for accurate localization of multigland disease ranges from 43 to 69% [37,45,66,67]. Between 57 and 75% of lesions missed by 4DCT in the reoperative setting constitute multigland disease [64,68]. In addition to comprising a substantial proportion of reoperative patients, patients with multigland disease are also more likely to have milder hypercalcemia and smaller lesions than patients with single-gland disease [67,69].…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

“…Unlike ultrasound and sestamibi scintigraphy, 4DCT does not significantly differ in accuracy between unexplored patients and reoperative patients [63]. e modality is also superior to ultrasound and sestamibi scintigraphy in the preoperative localization of persistent or recurrent disease [37,64,71,74,75]. In addition, 4DCT accurately identifies parathyroid disease in challenging reoperative patients, such as those with negative first-line imaging or multigland disease [28,37,45,66,67,72].…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

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Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Parikh

Grogan

Morón

2020

International Journal of Endocrinology

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The localization of persistent or recurrent disease in reoperative patients with primary hyperparathyroidism presents challenges for radiologists and surgeons alike. In this article, we summarize the relevant imaging modalities, compare their accuracy in identifying reoperative disease, and outline their advantages and disadvantages. Accurate localization by preoperative imaging is a predictor of operative success, whereas negative or discordant preoperative imaging is a risk factor for operative failure. Ultrasound is a common first-line modality because it is inexpensive, accessible, and radiation-free. However, it is highly operator-dependent and less accurate in the reoperative setting than in the primary setting. Sestamibi scintigraphy is superior to ultrasound in localizing reoperative disease but requires radiation, prolonged imaging times, and reader experience for accurate interpretation. Like ultrasound, sestamibi scintigraphy is less accurate in the reoperative setting because reoperative patients can exhibit distorted anatomy, altered perfusion of remaining glands, and interference of radiotracer uptake. Meanwhile, four-dimensional computed tomography (4DCT) is superior to ultrasound and sestamibi scintigraphy in localizing reoperative disease but requires the use of radiation and intravenous contrast. Both 4DCT and magnetic resonance imaging (MRI) do not significantly differ in accuracy between unexplored and reoperative patients. However, MRI is more costly, inaccessible, and time-consuming than 4DCT and is inappropriate as a first-line modality. Hybrid imaging with positron emission tomography and computed tomography (PET/CT) may be a promising second-line modality in the reoperative setting, particularly when first-line modalities are discordant or inconclusive. Lastly, selective venous sampling should be reserved for challenging cases in which noninvasive modalities are negative or discordant. In the challenging population of reoperative patients with PHPT, a multimodality approach that utilizes the expertise of high-volume centers can accurately localize persistent or recurrent disease and enable curative parathyroidectomy.

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“…Different methods for localization of PTG have been used in the last three decades, such as high-resolution ultrasonography, scintigraphy imaging, computerized tomography (conventional and new 4D), and magnetic resonance imaging 11 . All these methods have varying rates of success, so it is difficult to suggest any single imaging modality to be routinely used before surgical neck exploration [13][14][15] . High-resolution ultrasonography was first described as a method for detection of PT tumours in 1979 by Edis and Evans 16 .…”

Section: Introductionmentioning

confidence: 99%

The accuracy of ultrasonography for detection of enlarged parathyroid glands in patients with different forms of hyperparathyroidism

2020

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Background/Aim:Ultrasonography is a cheap, easily available and convenient method for diagnosis. The aim of this study was: to determine the utility of ultrasonography for preoperative identification and localization of enlarged parathyroid glands (PTG) in patients with different forms of hyperparathyroidism (HPT); to examine the frequency of PTG detection in patients previously non-suspected for HPT but having symptoms relevant to the disease; to determine sensitivity and positive predictive value (PPV) of ultrasonography for identification of PTG in HPT and to compare them with scintigraphy. Methods: This investigation was designed as a retrospectiveprospective study. The total number of patients undergoing ultrasonography prior to surgery was 179 and the number of those subjected to scintigraphy, mostly by the 201 Tl/ 99m Tc method, was 112. The patients (52 male; 128 female) were divided into the following four groups: group Apatients with primary (p)HPT (n=78); group Bpatients with secondary (s)HPT (n=47); group Cpatients with tertiary (t)HPT (n=13); group Dpatients with unrecognized (u)HPT, but with anamnestic data implying the disease (n=42). High resolution ultrasonography was performed by a single experienced observer. Diagnosis of HPT was based on characteristic clinical and biochemical parameters. Final proof of HPT diagnosis was surgery followed by histopathological examination. Results: Ultrasonography detected enlarged PTG in 93.85% of total patients, whereas scintigraphy uncovered 75.89% positive cases (p<0.05). The total number of positive PTG detected by ultrasonography was 211 versus 225 detected by surgery (sensitivity-95.9%; PPV-99.4%). Histopathology confirmed the predominance of adenoma in A and D groups in comparison with B group of patients having PTG hyperplasia.Group C was characterized by the presence of adenomas in hyperplastic PTG. The mean size of PTG measured by ultrasonography was 17.59 ± 8.0mm (n=164) versus18.36 ± 8.54mm (n=179),measured after surgery. Ultrasonography proved itself as an accurate technique in all HPT groups, regarding its high sensitivity (range 93.6-100%) and PPV (95.6-100%). In contrast, scintigraphy was shown to be less reliable, especially in sPTH group (sensitivity: 51.7%; PPV: 78.4%). Conclusion: Ultrasonography is more sensitive and accurate method for pre-opreative localization of PTG in comparison with 201 Tl/ 99m Tc scintigraphy. It can be also efficiently used for detection of PTG and diagnosis of HPT in patients previously not suspected for this disease.

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4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease

Abstract: 4D-CT localized parathyroid adenomas with higher sensitivity among patients with recurrent or persistent PHPT compared with sestamibi or US-based imaging.

Cited by 43 publications

References 28 publications

Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism

Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

The accuracy of ultrasonography for detection of enlarged parathyroid glands in patients with different forms of hyperparathyroidism

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