Objective: The present study was designed to evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT).
Study design: Case series with expertized image review.
Setting: Tertiary care hospital.
Subjects and methods: A total of 38 patients were recruited for study, all of whom had undergone focused parathyroidectomy for single-lesion primary HPT between June 2011 and September 2013. In each patient, 3 imaging procedures were performed: cervical ultrasonography (US), 99mTc-sestamibi SPECT/CT (SeS), and 4D CT. Collective imaging data were blindly reviewed and compared.
Results: 4D CT outperformed US and SeS in terms of sensitivity (P=.27), specificity (P=.01), positive predictive value (PPV) (P<.01), negative predictive value (NPV) (P=.19), and accuracy (P<.01). In 7.9% (3/38) of patients, 4D CT provided specific anatomic information that was unaffordable by US and SeS. Localization by 4D CT correlated with tissue parathyroid hormone level (P=.02), maximum diameter (P=.01), and volume (P<.01) of abnormal parathyroid glands.
Conclusion: 4D CT proved helpful in localizing target parathyroid glands of primary HPT that were missed by traditional imaging.
Keywords: 4-dimensional computed tomography; 99mTc sestamibi SPECT/CT; minimally invasive surgical procedures; primary hyperparathyroidism; ultrasonography.
© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.