Comparison of 4D CT, ultrasonography, and 99mTc sestamibi SPECT/CT in localizing single-gland primary hyperparathyroidism

• Published in: Otolaryngology-head and neck surgery Vol. 152; no. 3; p. 438
• Main Authors: Suh, Yong Joon, Choi, June Young, Kim, Su-jin, Chun, In Kook, Yun, Tae Jin, Lee, Kyu Eun, Kim, Ji-hoon, Cheon, Gi Jeong, Youn, Yeo-Kyu
• Format: Journal Article
• Language: English
• Published: England 01.03.2015
• Subjects: Female; Four-Dimensional Computed Tomography - methods; Humans; Hyperparathyroidism, Primary - diagnosis; Male; Middle Aged; Multidetector Computed Tomography - methods; Predictive Value of Tests; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; ROC Curve; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon - methods; Ultrasonography, Doppler, Color - methods; 99mTc sestamibi SPECT/CT; minimally invasive surgical procedures; primary hyperparathyroidism; ultrasonography; 4-dimensional computed tomography
• ISSN: 1097-6817
• DOI: 10.1177/0194599814562195

The present study was designed to evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT). Case series with expertized image review. Tertiary care hospital. 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. 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. 4D CT proved helpful in localizing target parathyroid glands of primary HPT that were missed by traditional imaging.