Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma/hyperplasia in primary hyperparathyroidism

Abstract

We propose that percentage arterial enhancement can be used as an objective radiological index for accurate identification of parathyroid adenoma/hyperplasia.

Comparison of 68Ga-DOTA-NaI3-Octreotide/tyr3-octreotate positron emission tomography/computed tomography and contrast-enhanced computed tomography in localization of tumors in multiple endocrine neoplasia 1 syndrome

“…CECT has been shown to be more sensitive than Tc-99m-sesta-methoxyisobutylisonitrile (SestaMIBI) scan (44%), other routinely used imaging modality, for detection of multiglandular parathyroid disease of MEN1. [ 11 ] This finding may also be extrapolated to multiglandular sporadic disease, and CECT may have better sensitivity to identify multiglandular involvement in sporadic PHPT patients. However, most of the studies report less sensitivity of CECT for multiglandular PHPT and varies from 29% to 85%.…”

“…68 Ga DOTA-NOC/TATE PET/CT-negative parathyroid lesions were 12 ± 9.5 mm. They were detected on CECT based on contrast enhancement on arterial phase CT.[ 11 ] Sensitivity of 68 Ga-DOTA-NOC PET/CT (9/29) and 68 Ga-DOTA TATE PET/CT (8/40) was comparable for the detection of metastasis. ( P = 0.29) Tc99m-sestamibi scan was not done.…”

Primary hyperparathyroidism

“…Radiation exposure to neck by 4D-CT is relatively high and its usage is limited to first investigation in order to diagnose of primary parathyroidism. Exposure to radiation should be restricted if possible, so evaluation of the percentage arterial enhancement as objective radiological index can be helpful, and used to determine parathyroid lesions (adenoma/hyperplasia) and discriminate it from thyroid tissue and lymph nodes [32]. Positron emission and computed tomography (PET/CT) may also be performed as a non-invasive diagnostic method.…”

Parathyroid glands: variation in number, size and location

“…Percentage arterial enhancement can be used as an objective radiological index for accurate detection of parathyroid adenoma/ hyperplasia, and for discriminating parathyroid lesions from thyroid tissue and lymph nodes. 23 In aminolevulinic acid-induced fluorescence technique, adenomatous and atrophied PTGs could be easily detected and excised due to their intense red fluorescence whereas surrounding thyroid and muscle tissue remained nonfluorescent and easily discriminated from the PTGs. 24…”