The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism

Jong, Mechteld C. de; Jamal, Karim; Morley, Simon; Beale, Timothy; Chung, Teng-Teng; Jawad, Susan; Hurel, Steven J.; Simpson, Helen; Srirangalingam, Umasuthan; Baldeweg, Stephanie E; García, Virginia Rozalén; Otero, Sofia; Shawky, Mohamed; Abdel-Aziz, Tarek Ezzat; Kurzawinski, Tom

doi:10.1007/s42000-020-00205-x

Cited by 4 publications

(3 citation statements)

References 50 publications

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“…De Jong et al showed that the combination of US and 4DCT had the highest sensitivity as a first-line imaging strategy, higher than the combination of US and MIBI (88% vs. 65%). 4DCT alone has a sensitivity of 87%, using a three-phase protocol (Jong et al 2021 ). Leong et al also showed a high sensitivity by using 4DCT as first-line imaging, with a sensitivity of 82.5%, which was higher for head and neck radiologists compared to general radiologists (Leong et al 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…First-line imaging strategy in most hospitals is a combination of neck ultrasound (US) and [ 99m Tc]Tc-Sestamibi SPECT (MIBI). Sensitivity of this combination varies between 65% and 97.4% (Jong et al 2021 ; Abd Elhameed Elsayed and Ali 2019 ). When the combination of US and MIBI SPECT has a negative or discordant result, further imaging is required.…”

Section: Introductionmentioning

confidence: 99%

“…Depending on local experience and availability, this may be a four-dimensional computed tomography (4DCT) or [ 18 F]fluorocholine PET/CT (FCH) with sensitivities ranging between 75 and 97% for 4DCT and 85-97% for PET/CT (Bahl et al 2014 ; Bunch et al 2022 ; Ballester Vazquez et al 2020 ; Broos et al 2019a , b ). Few articles describe the role of 4DCT as first-line imaging technique (Jong et al 2021 ; Leong et al 2021 ). The present paper compares 4DCT as first-line imaging to the conventional combination of US and MIBI.…”

Section: Introductionmentioning

confidence: 99%

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Four-dimensional computed tomography as first-line imaging in primary hyperparathyroidism, a retrospective comparison to conventional imaging in a predominantly single adenoma population

Krol,

Joosten,

de Boer

et al. 2024

EJNMMI Rep.

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Background To determine the use of four-dimensional CT as first-line imaging compared to the traditional combination of ultrasound and [99mTc]Tc-Sestamibi SPECT. Materials and methods Retrospective review of preoperative imaging in patients with primary hyperparathyroidism, who underwent parathyroidectomy between 2012 and 2021. In one group, the combination ultrasound and [99mTc]Tc-Sestamibi SPECT was used as first-line imaging (n = 54), in the other group four-dimensional CT was the first-line imaging modality (n = 51). Sensitivity and positive predictive value were calculated on patient, lateralisation and localisation level. The need for additional imaging was also assessed for both groups. Results Four-dimensional CT had a significantly higher sensitivity compared to the combination of ultrasound/[99mTc]Tc-Sestamibi SPECT on patient and localisation level (70.6% vs. 51.9%, p = 0.049 and 60.8% vs. 35.2%, p = 0.009 respectively). Sensitivity for lateralisation also appeared higher, but did not reach significance (62.7% vs. 44.4%, p = 0.060). Positive predictive value was not significantly higher for four-dimensional CT compared to ultrasound and [99mTc]Tc-Sestamibi SPECT (88.9% vs. 85.7% for lateralisation and 86.1% vs. 67.9% for localisation respectively). Additional imaging was required in 14 patients with four-dimensional CT as first-line imaging (27.4%) consisting of 2 ultrasound/[99mTc]Tc-Sestamibi SPECT and 13 [18F]fluorocholine PET/CT, compared to 24 patients with ultrasound/[99mTc]Tc-Sestamibi SPECT as first-line imaging (44.4%), requiring 22 four-dimensional CT and 9 [18F]fluorocholine PET/CT. Conclusions Four-dimensional CT as the sole first-line parathyroid imaging modality had higher sensitivity than the combination of ultrasound and [99mTc]Tc-Sestamibi SPECT, therefore requiring fewer additional procedures. Although the most costly, [18F]fluorocholine PET/CT was the most effective technique to localise parathyroid adenoma in case all other imaging was negative.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Four-dimensional computed tomography as first-line imaging in primary hyperparathyroidism, a retrospective comparison to conventional imaging in a predominantly single adenoma population

Krol,

Joosten,

de Boer

et al. 2024

EJNMMI Rep.

View full text Add to dashboard Cite

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Discordant Ultrasound Scan and Technetium 99m Sestamibi Scan

Agarwal

Fernando

Parameswaran

et al. 2023

Case Studies in Thyroid and Parathyroid Tumors

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The development of patient-specific 3D anatomical models in minimally invasive parathyroidectomy

Haq,

Ahmed,

Abdelsalam

et al. 2024

Front. Endocrinol.

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BackgroundSurgery is the preferred treatment for primary hyperparathyroidism. Minimally invasive parathyroidectomy is only feasible with accurate preoperative localisation. Virtual 3D anatomical models can be constructed from patient-specific CT scans using segmentation software.MethodsWe aimed to create virtual 3D models from 4D-CT scans of parathyroid tumours using segmentation technology. We designed a small pilot study to assess the utility of 3D models within surgical practice. We assessed surgeon, trainee and patients’ opinion and satisfaction with the models. The NASA TLX survey was the primary data collection toolResultsCreation of novel 3D models was achieved, these featured a 360-degree axis of rotation and transparency mode to assist in surgical planning. Models were used intraoperatively with the HoloLens 2 headset to locate parathyroid tumours real time before surgery. Total mean workloads for surgery planning when averaged revealed a decrease workload (39.45 vs 27.45) points with adjunctive use of models (p=0.002). Mental demand showed the greatest decrease in mean workload out of all the 6 subscales tested for in the NASA TLX (210.3 vs 136.7) points. Patient satisfaction score was statistically significant for the difference before and after seeing the 3D model regarding anatomical location (p=≤0.001),ConclusionIn this work, we developed patient-specific virtual 3D anatomical models of parathyroid tumours for use in surgery using novel techniques, previously never applied to parathyroidectomy. Our initial success in model construction and subsequent opinion of surgeons, trainees and patients contributes to the developing body of literature in favour of virtual modelling for parathyroidectomy.

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The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism

Cited by 4 publications

References 50 publications

Four-dimensional computed tomography as first-line imaging in primary hyperparathyroidism, a retrospective comparison to conventional imaging in a predominantly single adenoma population

Four-dimensional computed tomography as first-line imaging in primary hyperparathyroidism, a retrospective comparison to conventional imaging in a predominantly single adenoma population

Discordant Ultrasound Scan and Technetium 99m Sestamibi Scan

The development of patient-specific 3D anatomical models in minimally invasive parathyroidectomy

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