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4D Parathyroid CT as the Initial Localization Study for Patients with De Novo Primary Hyperparathyroidism

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

Abstract

Background

Preoperative localization of parathyroid tumors of primary hyperparathyroidism (pHPT) is required for minimally invasive parathyroidectomy (MIP). Parathyroid four-dimensional computed tomography (4DCT) has mainly been used as an adjunct to other imaging modalities in the remedial setting. 4DCT was evaluated as the initial localization study in de novo patients with pHPT.

Materials and Methods

A total of 87 consecutive patients underwent parathyroidectomy for pHPT from August 2008 to November 2009. 4DCT was introduced as the preferred imaging modality instead of sestamibi with SPECT (SeS) in April 2009. Results of the imaging studies [4DCT, SeS, and ultrasonography (US)], operative and, pathologic findings, and biochemical measurements were evaluated.

Results

In this study, 84% of patients (73 of 87) underwent an US, 59.8% (52 of 87) a SeS, and 38.0% (33 of 87) had a 4DCT. 4DCT had improved sensitivity (85.7%) over SeS (40.4%) and US (48.0%) to localize parathyroid tumors to the correct quadrant of the neck (P < 0.005) as well as to localize (lateralize) the parathyroid lesions to one side of the neck (93.9% for 4DCT vs. 71.2% for US and 61.5% for SeS; P < 0.005). 4DCT correctly predicted multiglandular disease (MGD) in 85.7% (6 of 7) patients, whereas US and SeS were unable to detect MGD in any case. All patients achieved cure based on intraoperative parathyroid hormone (PTH) measurements and normalization of intact PTH and S-Ca during follow-up.

Conclusions

4DCT provides significantly greater sensitivity than SeS and US for precise localization of parathyroid tumors of pHPT. Additionally, it correctly predicted MGD in a majority of patients.

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Authors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    Lee F. Starker MD, Peyman Björklund PhD, Robert Udelsman MD, MBA & Tobias Carling MD, PhD

  2. Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA

    Amit Mahajan MD & Gordon Sze MD

Authors
  1. Lee F. Starker MD
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  2. Amit Mahajan MD
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  3. Peyman Björklund PhD
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  4. Gordon Sze MD
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  5. Robert Udelsman MD, MBA
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  6. Tobias Carling MD, PhD
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Correspondence to Tobias Carling MD, PhD.

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Starker, L.F., Mahajan, A., Björklund, P. et al. 4D Parathyroid CT as the Initial Localization Study for Patients with De Novo Primary Hyperparathyroidism. Ann Surg Oncol 18, 1723–1728 (2011). https://doi.org/10.1245/s10434-010-1507-0

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  • DOI: https://doi.org/10.1245/s10434-010-1507-0

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