Minimally Invasive Surgery for Solitary Parathyroid Adenomas in Patients with Primary Hyperparathyroidism: Role of US with Supplemental CT

Dalen, A. Van; Smit, Casper; Vroonhoven, Theo J. M. V. van; Burger, Huibert; Lange, Eduard E. de

doi:10.1148/radiol.2203000998

Cited by 73 publications

(41 citation statements)

References 18 publications

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“…The success of minimally invasive parathyroidectomy depends on the appropriate selection of candidates-namely, those with localizable adenomas on preoperative imaging. 18 A number of imaging modalities, including radionuclide scintigraphy, sonography, and CT, are currently used, both alone and in combination, for localization purposes, with varying levels of success.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“…14,15 In some studies, US sensitivity decreased in the presence of multinodular goiter and when the adenoma was located in sonographically ''silent'' regions, such as the upper mediastinum and the retroesophageal area. 3,6,17 To perform a minimally invasive parathyroidectomy, the surgeon must have precise information on the location of the adenoma in the neck. In this study, we evaluated the ability of US to pinpoint the adenoma.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive procedure for resection of a parathyroid adenoma: The role of preoperative high-resolution ultrasonography

Gilat

Cohen

Feinmesser

et al. 2005

J. Clin. Ultrasound

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“…Single-phase arterial imaging has been advocated in 1 study as an adjunctive test to sonography. 1 We found that imaging in the arterial phase alone could be helpful, based on the tissue-vascular ratios, but there would be foreseeable circumstances in which high-attenuation thyroid nodules may be difficult to differentiate from PTH-secreting lesions. Kutler et al 10 address this potential pitfall by combining an early postcontrast phase (50 seconds delay) with a noncontrast phase CT. We did not study the role of the noncontrast phase and compare it with our protocol, but an advantage of our protocol, with 2 contrasted phases, is that it provides contrast washout information, which allows potential lesions to be assessed visually or quantitatively in the form of calculated relative enhancement washout percentages.…”

Section: Discussionmentioning

confidence: 87%

Parathyroid Lesions: Characterization with Dual-Phase Arterial and Venous Enhanced CT of the Neck

Gafton

Glastonbury

Eastwood

et al. 2012

AJNR Am J Neuroradiol

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SUMMARY:This clinical report describes the enhancement characteristics of hypersecreting parathyroid lesions on dual-phase neck CT. We retrospectively analyzed the enhancement characteristics of 5 pathologically confirmed PTH-secreting lesions on dual-phase CT examinations. Attenuation values were measured for PTH-secreting lesions, vascular structures (CCA and IJV), and soft tissue structures (thyroid gland, jugulodigastric lymph node, and submandibular gland). From the attenuation values, "relative enhancement washout percentage" and "tissue-vascular ratio" were calculated and compared. All lesions decreased in attenuation from arterial to venous phase, while the mean attenuation values of other soft tissue structures increased. A high relative enhancement washout percentage was correlated with parathyroid lesions (P Ͻ .006). The tissue-CCA ratio and tissue-IJV ratio for PTHsecreting lesions in the arterial phase were statistically significantly higher compared with soft tissue structures (P Ͻ .05). If these results are validated in future larger studies, noncontrast and delayed venous phases of 4D-CT could be eliminated to markedly reduce radiation exposure.ABBREVIATIONS: CCA ϭ common carotid artery; HU ϭ Hounsfield units; IJV ϭ internal jugular vein; PTH ϭ parathyroid hormone; ROC ϭ receiver operating characteristic curve M ost cases of primary hyperparathyroidism are due to benign parathyroid adenomas and parathyroid hyperplasia. These lesions are sometimes difficult to identify at surgery and on imaging due to variations in number and location of abnormal parathyroid glands, with multiglandular hyperplasia and multiglandular adenomas occurring in up to 14% of cases.1,2 Ectopic parathyroid adenomas and ectopic parathyroid hyperplasia account for 20 -25% of cases.3,4 Initial work-up in a patient with primary hyperparathyroidism usually consists of sonography or technetium (Tc)99m sestamibi scintigraphy with or without SPECT imaging. When these tests are negative, second-tier imaging investigations, such as 4D-CT and MR imaging of the neck, can be helpful in preoperative planning.The original description of 4D-CT includes image sets in 3 planes (axial, coronal, and sagittal).5 The "fourth" dimension of 4D-CT is the perfusion information derived from noncontrast, arterial, and venous phase imaging. Since this paper was published, different institutions have produced modified protocols. Some have interpreted "4D" as a 4-phase neck CT with precontrast and 3 postcontrast phases of neck imaging. 6-9Others image with precontrast and single postcontrast neck phases, 10 or postcontrast arterial and venous phases only. 11Because of these multiple phases of imaging, 4D-CT has been criticized for its high radiation dose. To reduce radiation dose, but still obtain perfusion information that might allow detection of parathyroid lesions, we have modified the protocol at our institution to dual-phase scanning with only arterial and venous phase imaging. The aim of this clinical report is to describe the enhancement characte...

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Minimally Invasive Surgery for Solitary Parathyroid Adenomas in Patients with Primary Hyperparathyroidism: Role of US with Supplemental CT

Abstract: US examination of patients with primary hyperparathyroidism allowed successful selection for minimally invasive surgery in more than two-thirds of the cases, with additional CT useful chiefly for surgical road mapping.

Cited by 73 publications

References 18 publications

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

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

Minimally invasive procedure for resection of a parathyroid adenoma: The role of preoperative high-resolution ultrasonography

Parathyroid Lesions: Characterization with Dual-Phase Arterial and Venous Enhanced CT of the Neck

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