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Dynamic Parathyroid Computed Tomography (4DCT) Facilitates Reoperative Parathyroidectomy and Enables Cure of Missed Hyperplasia

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Four-dimensional computed tomography (4DCT) is an emerging imaging modality in the evaluation of primary hyperparathyroidism (PHPT). We assessed the role of 4DCT in patients presenting for reoperative parathyroidectomy.

Methods

A prospective database of patients with persistent or recurrent PHPT undergoing reoperative parathyroidectomy during the years 2006–2014 was analyzed. Patients treated before versus after the advent of 4DCT were compared for operative eligibility, operative success, operative time, and concordance of imaging results with surgical findings.

Results

Ninety patients were included in the study (61 before 4DCT, 29 after 4DCT). The post-4DCT group had a higher rate of surgical concordance with imaging results (63 vs. 90 %, p < 0.01) and shorter operative time (114 vs. 76 min, p < 0.05). The operative success rate was not different (87 vs. 86 %). A similar pattern was observed in the subset of sestamibi-negative patients, with post-4DCT patients having a higher rate of surgical concordance (12 vs. 83 %, p < 0.0001) and shorter operative time (181 vs. 89 min, p < 0.05). Among patients ultimately found to have parathyroid hyperplasia, 4DCT correctly identified multiple enlarged glands in 80 % (4 of 5) and correctly lateralized one or more glands in 100 % (5 of 5) of cases, facilitating successful subtotal parathyroidectomy in the reoperative setting.

Conclusions

4DCT enables successful and efficient reoperative parathyroidectomy. These benefits extend to difficult cases, including sestamibi-negative patients and those with missed hyperplasia.

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Acknowledgments

The authors would like to thank Ning Li for her assistance with the statistical analysis.

Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Section of Endocrine Surgery, Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Stephanie Cham BS, Kimberly E. Hall BS, Michael W. Yeh MD & Avital Harari MD, MSc

  2. Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Ali R. Sepahdari MD

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  1. Stephanie Cham BS
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  2. Ali R. Sepahdari MD
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  3. Kimberly E. Hall BS
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  4. Michael W. Yeh MD
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  5. Avital Harari MD, MSc
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Correspondence to Avital Harari MD, MSc.

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Cham, S., Sepahdari, A.R., Hall, K.E. et al. Dynamic Parathyroid Computed Tomography (4DCT) Facilitates Reoperative Parathyroidectomy and Enables Cure of Missed Hyperplasia. Ann Surg Oncol 22, 3537–3542 (2015). https://doi.org/10.1245/s10434-014-4331-0

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  • DOI: https://doi.org/10.1245/s10434-014-4331-0

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