Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: a retrospective review

Abstract

ObjectiveThis study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism.MethodsThe CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas.ResultsThe parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p = 0.695). These results are similar to those found in the literature for multiphase CT of 55–94%.ConclusionsOur study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: a single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.

Dual-Energy Parathyroid 4D-CT: Improved Discrimination of Parathyroid Lesions from Thyroid Tissue Using Noncontrast 40-keV Virtual Monoenergetic Images

“…Some authors have advocated for omitting the true noncontrast phase as nonessential. 23,26,27 However, in our experience, the true noncontrast phase is indispensable because it improves sensitivity by enabling detection of parathyroid lesions that would be otherwise overlooked (eg, abutting and isoattenuating to thyroid on contrast-enhanced phases), and it decreases falsepositive candidate lesions by facilitating accurate characterization of exophytic thyroid tissue on the basis of intrinsic iodine content. To minimize adverse effects of the additional 40-keV VMI series on workflow, the 40-keV VMI are automatically generated and sent to the PACS at our institution, thus requiring no manual processing by the radiologist.…”

Localization of Parathyroid Disease in Reoperative Patients with Primary Hyperparathyroidism

“…Undergoing a 4DCT study increases a patient's lifetime attributable risk for cancer incidence over baseline by 0.52% [92]. Efforts to reduce the radiation dose from four-phase 4DCT protocols have spurred the use of two-phase protocols (consisting of precontrast and early arterial phases only) or even a singlephase protocol [103]. When used as a second-line modality, there is no significant difference in ability to lateralize parathyroid lesions between four-phase protocols and twoor three-phase protocols, including in reoperative patients and patients with multigland disease [63,65].…”