Abstract
BACKGROUND AND PURPOSE: Our aim was to test the hypothesis that our recently introduced 4D–dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation.
MATERIALS AND METHODS: Inclusion criteria were the following: 1) confirmed biochemical diagnosis of primary hyperparathyroidism, 2) preoperative 4D–dynamic contrast-enhanced MR imaging, and 3) surgical cure with >50% decrease in serum parathyroid hormone intraoperatively. 4D–dynamic contrast-enhanced studies were reviewed independently by 2 neuroradiologists to identify the side, quadrant, and number of abnormal glands, and compared with surgical and pathologic results.
RESULTS: Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease (9 with double-gland hyperplasia; 3 with 3-gland hyperplasia; and 5 with 4-gland hyperplasia). Interobserver agreement (κ) for the side (right versus left) was 0.92 for single-gland disease and 0.70 for multigland disease. Interobserver agreement for the quadrant (superior versus inferior) was 0.70 for single-gland disease and 0.69 for multigland disease. For single-gland disease, the gland was correctly located in 34/37 (92%) patients, with correct identification of the side in 37/37 (100%) and the quadrant in 34/37 (92%) patients. For multigland disease, the glands were correctly located in 35/47 (74%) patients, with correct identification of the side in 35/47 (74%) and the quadrant in 36/47 (77%).
CONCLUSIONS: The proposed high spatial and temporal resolution 4D–dynamic contrast-enhanced MR imaging provides excellent diagnostic performance for preoperative localization in primary hyperparathyroidism, with correct gland localization of 92% for single-gland disease and 74% in multigland disease, superior to 4D-CT studies.
ABBREVIATIONS:
- CAIPIRINHA
- controlled aliasing in parallel imaging results in higher acceleration
- DCE
- dynamic contrast-enhanced
- MGD
- multigland disease
- PHPT
- primary hyperparathyroidism
- PTA
- single parathyroid adenoma
- PTH
- parathyroid hormone
- SGD
- single-gland disease
- TRICKS
- time-resolved imaging of contrast kinetics
- TWIST
- time-resolved imaging with stochastic trajectories
Footnotes
Disclosures: Jennifer L. Becker—UNRELATED: Consultancy: Siemens, Comments: Syngo Via consultancy.* Randall P. Owen—UNRELATED: Grants/Grants Pending: Neurovision Medical Products, Comments: grant for intraoperative video laryngoscopy.* Kambiz Nael—UNRELATED: Board Membership: Olea Medical, Comments: Medical Advisory Board. *Money paid to the institution.
- © 2020 by American Journal of Neuroradiology