Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: How many phases do we really need?

Noureldine, Salem I.; Aygün, Nafi; Walden, Michael J.; Hassoon, Ahmed; Gujar, Sachin K.; Tufano, Ralph P.

doi:10.1016/j.surg.2014.08.002

Cited by 40 publications

(28 citation statements)

References 13 publications

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“…6,[7][8][9][10] These authors have reported equivalent diagnostic accuracy in localising parathyroid adenomas but with the added benefit of reducing the dose of radiation imparted to the patients. We have also demonstrated a significantly lower total effective radiation dose from threephase CT examinations, which is, as a result, associated with lower risks for lung and thyroid cancer compared with four-phase imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Both of these methods for calculating patient effective and organ absorbed radiation doses from CT and sestamibi scan examinations have been used in a previous published study. 9 Both techniques were used to calculate radiation doses for each individual patient in our cohort.…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have investigated using three or two phases instead of four to reduce the radiation dose. 6,[7][8][9][10] Only one published study to date has evaluated both the patient-effective dose of radiation as well as the specific organ-absorbed doses for 4D CT. 11 This study also compared the radiation doses between 4D CT and sestamibi with single-photon emission CT (SPECT) imaging. It reported that the highest absorbed organ dose for 4D CT was seen in the thyroid, whereas for sestamibi imaging this was seen in the colon.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of the radiation dose exposure and associated cancer risks in patients having preoperative parathyroid localization

Moosvi

Smith

Hathorn

et al. 2017

annals

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OBJECTIVE The study aimed to evaluate the total effective and organ absorbed radiation doses associated with three-and fourphase parathyroid computed tomography (CT) and sestamibi scans used for the preoperative localisation of parathyroid adenomas in a cohort of patients with primary hyperparathyroidism at a single institution. We aimed to assess the risk of cancer incidence for the organs demonstrating the highest absorbed doses for the different imaging techniques, and more specifically determine the risk for our cohort of patients. METHODS Fifty patients with primary hyperparathyroidism had both multiphase CT and sestamibi scans. The Imaging Performance Assessment of CT Scanners (ImPACT) calculator was used to estimate the patient-effective and organ-absorbed radiations doses for all the CT examinations. For sestamibi scans, the US Nuclear Regulatory Commission NUREG/CR-6345 publication was used to estimate the dose for each patient. The attributable risks of cancer were calculated using the Health Protection Agency HPA-CRCE-028 publication. RESULTS The mean patient total effective doses were 15.9% ± 2.8 mSv, 20.2% ± 2.8 mSv and 5.6 ± 0.24 mSv for three-phase CT, four-phase CT and sestamibi examinations, respectively. In our cohort, the highest attributable lifetime risk was for lung cancer (0.03%) after multiphase CT. This compared with a tenfold lower risk for thyroid cancer (0.003%). After sestamibi, the highest risk was for colon cancer (0.06%). CONCLUSIONS Multiphase CT is associated with a higher radiation dose and thus a higher potential risk of cancer, but this risk is low in the older population that constituted the majority of our cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evaluation of the radiation dose exposure and associated cancer risks in patients having preoperative parathyroid localization

Moosvi

Smith

Hathorn

et al. 2017

annals

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“…The two exams in combination reach a 95% of sensitivity, but there are some case of silent imaging (26). More advanced imaging techniques can be useful in some circumstances: the Multiphase Computed Tomography is a well-detailed diagnostic tool, the results of which are still under evaluation (27); the Magnetic Resonance Imaging can help in the localization of mediastinal parathyroid (26). Other advanced diagnostic methods, such as the 18F-fluorodeoxyglucose, 11C-methionine and the 8F-fluorocholine-PET/CT have been studied with debated result, and only the last one showed, in a pilot study, encouraging results (28) and, in any case, these are costly and not widely diffused tools.…”

Section: Discussionmentioning

confidence: 99%

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

Melfa¹,

Raspanti²,

Attard³

et al. 2016

Gchir

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Primary hyperparathyroidism (PHPT) is the third most frequent disease among the endocrine disorders, with a prevalence of 1-3% in western countries. Moreover, it is the commonest cause of hypercalcemia (1-4). Nowadays, the PHPT is diagnosed increasingly due to the improvement of biochemical test; it allowed the precocious diagnosis and the identification of asymptomatic patients (5, 6). Conventional bilateral neck exploration remains the reference surgical technique, although the hyperproduction of the parathyroid hormone (PTH) is due to a single hyperfunctioning gland (most frequently a parathyroid adenoma) in a high percentage (70-95%) of cases. It could allow to perform a minimally invasive "focused" approach if the preoperative diagnosis of localization is not doubtful, especially in the presence of two concordant imaging procedures, such as ultrasounds (US) and 99mTc-Sestamibi Scintigraphy (MIBI) (2, 7-11). This focused approach can be performed under general as well as local anaesthesia and it is widely accepted for the sporadic, non-hereditary, uni-focal form (4). The goal of a minimally invasive approach can also be reached with the minimally invasive video-assisted parathyroidectomy (MIVAP), which is an adaptation of the mini-incision cervical procedures to the video-assisted gasless techniques (9,12,13

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“…1 The article cites delineation of hyperfunctioning parathyroid tissue from other structures by relating density on unenhanced CT to the rapidity of enhancement following contrast injection. The ''fourth dimension'' (4D) of perfusion over time has excellent predictive power for localization.…”

mentioning

confidence: 99%

Limiting the risks of radiation exposure in diagnostic imaging

Ray

Romero

et al. 2014

Surgery

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Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: How many phases do we really need?

Cited by 40 publications

References 13 publications

Evaluation of the radiation dose exposure and associated cancer risks in patients having preoperative parathyroid localization

Evaluation of the radiation dose exposure and associated cancer risks in patients having preoperative parathyroid localization

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

Limiting the risks of radiation exposure in diagnostic imaging

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