Elsevier

Surgery

Volume 140, Issue 6, December 2006, Pages 932-941
Surgery

American Association of Endocrine Surgeons
Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography

Presented at the 27th Annual Meeting of the American Association of Endocrine Surgeons, New York, New York, May, 2006.
https://doi.org/10.1016/j.surg.2006.07.028Get rights and content

Background

Four-dimensional computed tomography (4D-CT) provides both functional and highly detailed anatomic information about parathyroid tumors. The purpose of this study was to compare 4D-CT with sestamibi imaging and ultrasonography as methods for the accurate preoperative localization of hyperfunctioning parathyroid glands before parathyroidectomy.

Methods

A study of 75 patients with primary hyperparathyroidism was performed at a tertiary-care institution. Sestamibi imaging, ultrasonography, and 4D-CT were performed on each patient preoperatively. Results of the imaging studies were compared with operative findings, pathologic data, and biochemical measurements to assess the sensitivity and specificity of each of the imaging modalities.

Results

4D-CT demonstrated improved sensitivity (88%) over sestamibi imaging (65%) and ultrasonography (57%), when the imaging studies were used to localize (lateralize) hyperfunctioning parathyroid glands to 1 side of the neck. Moreover, when used to localize parathyroid tumors to the correct quadrant of the neck (ie, right inferior, right superior, left inferior, or left superior), the sensitivity of 4D-CT (70%) was significantly higher than sestamibi imaging (33%) and ultrasonography (29%).

Conclusion

4D-CT provides significantly greater sensitivity than sestamibi imaging and ultrasonography for precise (quadrant) localization of hyperfunctioning parathyroid glands. This allows improved preoperative planning, particularly for the case of reoperation. In addition to the data that are provided, we present a novel classification scheme for use in parathyroid localization.

Section snippets

Methods

For the purposes of this paper, standard definitions of commonly used terms have been incorporated into Table I.

Patients

Demographic and laboratory data are provided in Table II. The median age of patients at diagnosis was 60 years (range, 27-83 years), and the female-to-male ratio was 5.3 to 1. The median patient weight was 79.5 kg (range, 41.4-162.0 kg), and the median BMI was 29.5 kg/m2 (range 17.8-67.4 kg/m2). The median preoperative serum calcium level was 10.9 mg/dL (range, 9.7-16.0 mg/dL; normal, 8.4-10.2 mg/dL). The median preoperative PTH level was 118 pg/mL (range, 60-524 pg/mL; normal, 10-65 pg/mL).

Discussion

Most studies in the literature that address parathyroid imaging report the ability of an imaging modality to localize (lateralize) parathyroid tumors to the correct side of the neck.6, 9, 10, 11, 12, 13, 14 Sensitivity for lateralization by ultrasonography varies from 61% to 88%,6, 9, 10, 11, 12, 13, 14 whereas sensitivity for lateralization by sestamibi varies from 68% to 86%.6, 9, 10, 12, 13 Using lateralization to measure the performance of preoperative imaging modalities in the current

References (18)

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Supported in part by research funds from the Hamill Foundation and from the Department of Diagnostic Radiology at The University of Texas M.D. Anderson Cancer Center.

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