Prospective Validation of Two 4D-CT–Based Scoring Systems for Prediction of Multigland Disease in Primary Hyperparathyroidism

Sho, S.; Yilma, M.; Yeh, Michael W.; Livhits, Masha J.; Wu, James X.; Hoang, Jenny K.; Sepahdari, Ali R.

doi:10.3174/ajnr.a4948

Cited by 27 publications

(17 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients were excluded if they did not have a parathyroidectomy performed at UCLA (n = 227) or if their parathyroidectomy was not successful (intraoperative PTH level drop <50%) (n = 2). The final study cohort consisted of the remaining 411 patients (mean [SD] age, 59 [14] years; 325 [79.1%] female), 123 (29.9%). Follow-up information of at least 6 months was available for 165 of 411 patients (40.1%).…”

Section: Study Cohortmentioning

confidence: 99%

Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy

et al. 2017

View full text Add to dashboard Cite

show abstract

Section: Study Cohortmentioning

confidence: 99%

Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…proposed a scoring model based on the findings of fourdimensional computed tomography (CT-4D) images, including variables such as largest lesion size and number of lesions, in combination with biochemical data (preoperative calcium and PTH, and WIN) (24). However, the sensitivity of CT-4D to detect MGD remained low (32-53%), compared to its sensitivity for detecting SGD (88-93%) (25)(26)(27)(28).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

Serradilla-Martín¹,

Palomares-Cano²,

Cantalejo-Díaz³

et al. 2021

Gland Surg

View full text Add to dashboard Cite

Background: Focused parathyroidectomy is a safe technique for the treatment of primary hyperparathyroidism. The CaPTHUS score and the Wisconsin index are preoperative diagnostic tools designed to distinguish between single-and multigland disease. The aim of the study is to evaluate the usefulness of these models for predicting multiglandular disease in a European population.Methods: Retrospective review of a database of patients operated upon for primary hyperparathyroidism at a referral center. The sensitivity, specificity, positive and negative predictive values, and reliability of both scores for the prediction of multiglandular disease, were calculated. Receiver operating characteristic (ROC) curves were constructed to assess the sensitivity and specificity of CaPTHUS score and Wisconsin Index for predicting single-gland disease. A level of P<0.05 was accepted as significant.Results: Two hundred and eighty-one patients who underwent successful surgery from January 2001 to December 2018 were included. Single-gland disease was detected in 92.5%, and 73.7% had a CaPTHUS score of ≥3. The sensitivity, specificity, positive and negative predictive values of this model for predicting singlegland disease with a score of ≥3 were 76.9%, 66.7%, 96.6%, and 18.9% respectively. The area under the curve value of the CaPTHUS score for predicting single-gland disease was 0.74. A Wisconsin Index >2,000 and an excised gland weight above one gram presented a positive predictive value for single-gland disease of 92.5%.Conclusions: Despite the good performance of both scales, the established cut-off points did not definitively rule out parathyroid multiglandular disease in our population. In cases with a minimal suspicion of this condition, additional intraoperative techniques must be used, or bilateral neck explorations should be performed.

show abstract

“…However, this modality exhibits variable accuracy in patients with multigland disease ( Figure 6). 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].…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

“…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]. 4DCT is significantly more accurate than sestamibi scintigraphy at lateralizing parathyroid lesions in patients with mild hypercalcemia (<10.8 mg/dL) and low gland weights (<0.5 g) [70].…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

“…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]. Finally, because it can differentiate unilateral and bilateral disease in up to 96% of reoperative patients, 4DCT can enable targeted parathyroidectomies in difficult reoperative cases [37,39,76].…”

Section: Four-dimensional Computed Tomographymentioning

confidence: 99%

See 1 more Smart Citation

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Parikh

Grogan

Morón

2020

International Journal of Endocrinology

View full text Add to dashboard Cite

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.

show abstract

Prospective Validation of Two 4D-CT–Based Scoring Systems for Prediction of Multigland Disease in Primary Hyperparathyroidism

Cited by 27 publications

References 15 publications

Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy

Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy

Usefulness of the Wisconsin and CaPTHUS indices for predicting multiglandular disease in patients with primary hyperparathyroidism in a southern European population

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

Contact Info

Product

Resources

About