How to Perform Parathyroid 4D CT: Tips and Traps for Technique and Interpretation

Hoang, Jenny K.; Sung, Won Kyung; Bahl, Manisha; Phillips, C. Douglas

doi:10.1148/radiol.13122661

Cited by 142 publications

(124 citation statements)

References 31 publications

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“…However, in studies related to parathyroid adenoma localization, it has been reported that majority of cases originate in the inferior glands (30). Of the patients for whom complete data were available, it was observed that WCCA behaved like adenoma rather than WCCH with respect to localization.…”

Section: Discussionmentioning

confidence: 96%

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma

et al. 2017

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An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma INTRODUCTIONPrimary hyperparathyroidism is one of the most encountered endocrine pathologies, with an incidence of 21.6/100,000. In the etiology, the leading cause is solitary adenoma (87%-91%), generally originating from chief cells (1). Adenoma originating from more than one gland is a rarer event and comprises 2%-15% of all adenomas (2). The rare form (1%) of water-clear cell hyperplasia (WCCH) of hyperparathyroidism was first described by Albright et al. (3) in 1934. As adenoma in the etiology is even more uncommon, only 19 cases have been reported since 1994, and of those cases, adenoma was in both parathyroid glands in only one case (1,2,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20).Hypercalcemic crisis, which was first described by Hannas in 1939, is a severe and life-threatening condition of severe hypercalcemia progressing to associated failure of various systems (21). Of the known cases, the case reported here is the first of hypercalcemic crisis caused by water-cell clear adenoma (WCCA). In previous reports related to WCCA, the histopathological features of the disease have generally been the focus. The aim of this study was to present the preoperative and postoperative periods of the disease and to evaluate the clinical characteristics. Defining the clinical characteristics of these kinds of rare cases can be considered useful for clinicians.In this case report, we present a patient who was successfully treated for double WCCA, and the case is discussed in comparison with the 19 cases reported in literature. Objective: To evaluate the clinical characteristics of a patient operated for water-clear cell adenoma and to discuss these in the light of relevant literature. MATERIAL AND METHODS Material and Methods:PubMed and Google Scholar were searched to identify articles related to water-clear cell adenoma using the following keywords: parathyroid tissue, parathyroid gland, parathyroid cells, parathyroid adenoma, parathyroid hyperplasia, water-clear-cell, and water clear cell. The search included case reports, review articles, and original articles that had been published between January 1990 and November 2014 without any restrictions on language. All articles that contained information on the study population and treatment related data were identified and retrieved. In addition, an evaluation was of a case of a 47-year-old male patient with PHC who was treated at our clinic was conducted.Results: A total of 19 patients, including our new case, (age range: 18 to 81 years, mean±SD: 57.47±16.31 years) were included in the analysis. Eleven patients were female. Information about adenoma location was available from studies involving 17 patients and they indicated the following distribution of locations: left inferior (n=10), right superior (n=4). When preoperative imaging methods were examined, a false negative result was given by ultrasonography in 28.5% of patients and only 57.1% were positive on scintig...

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Section: Discussionmentioning

confidence: 96%

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma

et al. 2017

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“…[5][6][7] In the past decade, multiphase CT has emerged as an additional technique for adenoma localization. 1,2,[8][9][10][11][12][13][14] In addition to lesion identification, CT allows precise localization based on welldefined anatomic landmarks. Following its introduction, multiphase CT was referred to as 4D-CT. 9 The term "4D" referred to the 3 dimensions provided by the CT scan with the added dimen-sion of time due to the functional information offered by the multiple phases of imaging.…”

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confidence: 99%

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Griffith¹,

Chaudhary

Mahmood

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Minimally invasive parathyroidectomy requires accurate preoperative localization of suspected adenomas, and multiphase CT allows adenoma characterization while providing detailed anatomic information. The purpose of this study was to assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism.

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“…1 The characteristic features of parathyroid adenomas on 4D CT are low attenuation on noncontrast imaging, peak enhancement on the arterial phase, and washout of contrast on the venous phase. [2][3][4] These allow differentiation between a parathyroid adenoma and its mimics, such as thyroid nodules and lymph nodes.…”

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confidence: 99%

“…5,6 Small arteries cannot be seen on nuclear scintigraphy or MR imaging because of lower spatial resolution, and they have not been described on single venous phase CT, to our knowledge. In a recent review article, the authors noted the presence of a "polar vessel" sign on the arterial phase of 4D CT. 4 The polar vessel sign can represent either an enlarged feeding artery or a draining vein seen on the arterial phase of imaging, and it is characterized by a vessel that terminates in a parathyroid adenoma and that is larger than contralateral neck vessels in a similar location.…”

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confidence: 99%

Prevalence of the Polar Vessel Sign in Parathyroid Adenomas on the Arterial Phase of 4D CT

Bahl¹,

Muzaffar

Vij³

et al. 2013

AJNR Am J Neuroradiol

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How to Perform Parathyroid 4D CT: Tips and Traps for Technique and Interpretation

Cited by 142 publications

References 31 publications

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma

An unusual cause of hypercalcemic crisis: Water-clear cell double parathyroid adenoma

Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism

Prevalence of the Polar Vessel Sign in Parathyroid Adenomas on the Arterial Phase of 4D CT

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