Background
Four-dimensional computed tomography (4D-CT) utilizes multiplanar images and perfusion
characteristics to identify abnormal parathyroid glands. We assessed the role of 4D-CT
in patients with inconclusive preoperative ultrasound and sestamibi localization studies.
Methods
Adult patients with primary hyperparathyroidism with negative or discordant standard
imaging who underwent both localization with 4D-CT and operative intervention for
curative intent were included. Patient characteristics, 4D-CT scan results compared
with operative findings, and curative proportion were assessed.
Results
Of the 60 patients, 4D-CT accurately lateralized 73% and localized 60% of abnormal
glands found at operation. Single candidate lesions (46/60) were confirmed at operation
in 70%. When multiple lesions were identified on 4D-CT (14/60), accuracy dropped to
29% (P = .03). The accuracy of 4D-CT was not different between primary and reoperative cases
(P = .79). Of the 8 patients with multigland disease diagnosed perioperatively, 5 had
multiple candidate lesions noted on 4D-CT. In 94% (48/51) of patients, a >50% drop
in intraoperative parathormone (IOPTH) level was achieved after resection and 87%
(48/55) had long-term cure with a median follow-up of 221 days.
Conclusion
4D-CT identifies the more than half of abnormal parathyroids missed by traditional
imaging and should be considered in cases with negative or discordant sestamibi and
ultrasound. Bilateral exploration is warranted when multiple candidate lesions are
reported on 4D-CT. Multigland disease remains a challenging entity.
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Article info
Publication history
Accepted:
September 13,
2010
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
