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MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

  • Magnetic Resonance
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Abstract

Objectives

To identify frequent MRI features of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT) using a fast protocol with a 3 T magnet.

Methods

Thirty-eight patients with PHPT underwent a 3 T-MR. All patients had positive US and Tc-99 sestamibi, for a total number of 46 PTAs. T2-weighted IDEAL-FSE and T1 IDEAL-sequences, before and after contrast, were performed. Five features of PTAs were recognised: hyperintensity, homogeneous or "marbled" appearance and elongated morphology on T2-sequences; cleavage plane from thyroid gland on T2-outphase; rapid enhancement in post-contrast T1. Image quality for T2-weighted IDEAL FSE and usefulness for IDEAL post-contrast T1-weighted and T2-outphase sequences were also graded.

Results

PTAs were hyperintense in T2-sequences in 44/46 (95.7 %), "marbled" in 30/46 (65.2 %) and elongated in 38/46 (82.6 %) patients. Cleavage plane was observed in 36/46 (78.3 %), and rapid enhancement in 20/46 (43.5 %) patients. T2-sequences showed both excellent fat suppression and image quality (average scores of 3.2 and 3.1). T2-outphase images demonstrated to be quite useful (score 2.8), whereas, post-contrast T1 images showed a lower degree of utility (score 2.4).

Conclusions

A fast protocol with 3.0-T MRI, recognising most common features of PTAs, may be used as a second-line method in the preoperative detection of PTAs.

Key Points

• 3 T MRI protocol based on T2-weighted IDEAL FSE sequences was used.

• T2-hyperintensity and elongated morphology are common features of PTAs.

• 3 T MRI could be used in the preoperative detection of PTAs.

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References

  1. Fraser WD (2009) Hyperparathyroidism. Lancet 374:145–158

    Article  CAS  PubMed  Google Scholar 

  2. Bilezikian JP, Silverberg SJ (2004) Clinical practice. Asymptomatic primary hyperparathyroidism. N Engl J Med 350:1746–1751

    Article  CAS  PubMed  Google Scholar 

  3. Ruda JM, Hollenbeak CS, Stack BC Jr (2005) A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 132:359–372

    Article  PubMed  Google Scholar 

  4. Akerstrom G, Malmaeus J, Bergstrom R (1984) Surgical anatomy of human parathyroid glands. Surgery 95:14–21

    CAS  PubMed  Google Scholar 

  5. Eigelberger MS, Cheah WK, Ituarte PH et al (2004) The NIH criteria for parathyroidectomy in asymptomatic primary hyperparathyroidism: are they too limited? Ann Surg 239:528–535

    Article  PubMed Central  PubMed  Google Scholar 

  6. Silverberg SJ, Clarke BL, Peacock M et al (2014) Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the fourth international workshop. J Clin Endocrinol Metab 99:3580–3594

    Article  CAS  PubMed  Google Scholar 

  7. Bilezikian JP, Brandi ML, Eastell R et al (2014) Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the fourth international workshop. J Clin Endocrinol Metab 99:3561–3569

    Article  CAS  PubMed  Google Scholar 

  8. Wang CA (1976) The anatomic basis of parathyroid surgery. Ann Surg 183:271–275

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  9. Okuda I, NakajimaY MD et al (2010) Diagnostic localization of ectopic parathyroid lesions: developmental consideration. Jpn J Radiol 28:707–713

    Article  PubMed  Google Scholar 

  10. Low RA, Katz AD (1998) Parathyroidectomy via bilateral cervical exploration: a retrospective review of 866 cases. Head Neck 20:583–587

    Article  CAS  PubMed  Google Scholar 

  11. Udelsman R (2002) Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–670

    Article  PubMed Central  PubMed  Google Scholar 

  12. Miccoli P, Bendinelli C, Berti P et al (1999) Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: a prospective randomized study. Surgery 126:1117–1122

    Article  CAS  PubMed  Google Scholar 

  13. Howe JR (2000) Minimally invasive parathyroid surgery. Surg Clin N Am 80:1399–1426

    Article  CAS  PubMed  Google Scholar 

  14. Miccoli P, Barellini L, Monchik JM et al (2005) Randomized clinical trial comparing regional and general anaesthesia in minimally invasive video-assisted parathyroidectomy. Br J Surg 92:814–818

    Article  CAS  PubMed  Google Scholar 

  15. Grant CS, Thompson G, Farley D et al (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140:472–478

    Article  PubMed  Google Scholar 

  16. Barczynski M, Cichon S, Konturek A et al (2006) Minimally invasive video-assisted parathyroidectomy versus open minimally invasive parathyroidectomy for a solitary parathyroid adenoma: a prospective, randomized, blinded trial. World J Surg 30:721–731

    Article  PubMed  Google Scholar 

  17. Chen H, Mack E, Starling JR (2005) A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable? Ann Surg 242:375–383

    PubMed Central  PubMed  Google Scholar 

  18. Tublin ME, Pryma DA, Yim JH et al (2009) Localization of parathyroid adenomas by sonography and technetium Tc 99m sestamibi single-photon emission computed tomography before minimally invasive parathyroidectomy: are both studies really needed? J Ultrasound Med 28:183–190

    PubMed  Google Scholar 

  19. Vignali E, Picone A, Materazzi G et al (2002) A quick intraoperative parathyroid hormone assay in the surgical management of patients with primary hyperparathyroidism: a study of 206 consecutive cases. Eur J Endocrinol 146:783–788

    Article  CAS  PubMed  Google Scholar 

  20. Boudou P, Ibrahim F, Cormier C et al (2005) Third- or second-generation parathyroid hormone assays: a remaining debate in the diagnosis of primary hyperparathyroidism. J Clin Endocrinol Metab 90:6370–6372

    Article  CAS  PubMed  Google Scholar 

  21. Carneiro-Pla D (2009) Effectiveness of “office”-based, ultrasound-guided differential jugular venous sampling (DJVS) of parathormone in patients with primary hyperparathyroidism. Surgery 146:1014–1020

    Article  PubMed  Google Scholar 

  22. Johnson NA, Tublin ME, Ogilvie JB (2007) Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR 188:1706–1715

    Article  PubMed  Google Scholar 

  23. Phillips CD, Shatzkes DR (2012) Imaging of the parathyroid glands. Semin Ultrasound CT MR 33:123–129

    Article  PubMed  Google Scholar 

  24. Mohebati A, Shaha AR (2012) Imaging techniques in parathyroid surgery for primary hyperparathyroidism. Am J Otolaryngol 33:457–468

    Article  PubMed Central  PubMed  Google Scholar 

  25. Cakala E, Cakir E, Dillib A et al (2012) Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates. Clin Imaging 36:688–694

    Article  Google Scholar 

  26. Reeder SB, Desser TS, Weigel RJ et al (2002) Sonography in primary hyperparathyroidism: review with emphasis on scanning technique. J Ultrasound Med 21:539–552

    PubMed  Google Scholar 

  27. Gilat H, Cohen M, Feinmesser R et al (2005) Minimally invasive procedure for resection of a parathyroid adenoma: the role of preoperative high resolution ultrasonography. J Clin Ultrasound 33:283–287

    Article  PubMed  Google Scholar 

  28. Vitetta GM, Neri P, Chiecchio A et al (2014) Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy. J Ultrasound 31:1–12

    Article  Google Scholar 

  29. Van Husen R, Kim LT (2004) Accuracy of surgeon-performed ultrasound in parathyroid localization. World J Surg 28:1122–1126

    Article  PubMed  Google Scholar 

  30. Sofferman RA, Nathan MH, Fairbank JT et al (1996) Preoperative technetium Tc 99m sestamibi imaging: paving the way to minimal-access parathyroid surgery. Arch Otolaryngol Head Neck Surg 122:369–374

    Article  CAS  PubMed  Google Scholar 

  31. Allendorf J, Kim L, Chabot J et al (2003) The impact of sestamibi scanning on the outcome of parathyroid surgery. J Clin Endocrinol Metab 88:3015–3018

    Article  CAS  PubMed  Google Scholar 

  32. Palestro JC, Tomas MB, Tronco GG (2005) Radionuclide imaging of the parathyroid glands. Semin Nucl Med 35:266–276

    Article  PubMed  Google Scholar 

  33. Nichols KJ, Tomas MB, Tronco GG et al (2008) Preoperative parathyroid scintigraphic lesion localization: accuracy of various types of readings. Radiology 248:221–232

    Article  PubMed  Google Scholar 

  34. Lumachi F, Zucchetta P, Marzola MC et al (2000) Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol 143:755–760

    Article  CAS  PubMed  Google Scholar 

  35. Patel CN, Salahudeen HM, Lansdown M et al (2010) Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol 65:278–287

    Article  CAS  PubMed  Google Scholar 

  36. Kettle AG, O’Doherty MJ (2006) Parathyroid imaging: how good is it and how should it be done. Semin Nucl Med 36:206–211

    Article  PubMed  Google Scholar 

  37. Krudy AG, Doppman JL, Brennan MF et al (1981) The detection of mediastinal parathyroid glands by computed tomography, selective arteriography, and venous sampling: an analysis of 17 cases. Radiology 140:739–744

    Article  CAS  PubMed  Google Scholar 

  38. van Dalen A, Smit CP, van Vroonhoven TJMV et al (2001) Minimally invasive surgery for solitary parathyroid adenomas in patients with primary hyperparathyroidism: role of US with supplemental CT. Radiology 220:631–639

    Article  PubMed  Google Scholar 

  39. Lumachi F, Tregnaghi A, Zucchetta P et al (2004) Technetium-99m sestamibi scintigraphy and helical CT together in patients with primary hyperparathyroidism: a prospective clinical study. Br J Radiol 77:100–103

    Article  CAS  PubMed  Google Scholar 

  40. Rodgers SE, Hunter GJ, Hamberg LM et al (2006) Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery 140:932–940

    Article  PubMed  Google Scholar 

  41. Mortenson MM, Evans DB, Lee JE et al (2008) Parathyroid exploration in the reoperative neck: improved preoperative localization with 4D-computed tomography. J Am Coll Surg 206:888–895

    Article  PubMed  Google Scholar 

  42. Gotway MB, Higgins CB (2000) MR imaging of the thyroid and parathyroid glands. Magn Reson Imaging Clin N Am 8:163–182

    CAS  PubMed  Google Scholar 

  43. Lopez Hanninen E, Vogl TJ, Steinmuller T et al (2000) Preoperative contrast-enhanced MRI of the parathyroid glands in hyperparathyroidism. Investig Radiol 35:426–430

    Article  CAS  Google Scholar 

  44. Gotway MB, Reddy GP, Webb WR et al (2001) Comparison between MR imaging and 99mTc MIBI scintigraphy in the evaluation of recurrent or persistent hyperparathyroidism. Radiology 18:783–790

    Article  Google Scholar 

  45. Kabala JE (2008) Computed tomography and magnetic resonance imaging in diseases of the thyroid and parathyroid. Eur J Radiol 66:480–492

    Article  CAS  PubMed  Google Scholar 

  46. Michel L, Dupont M, Rosière A et al (2013) The rationale for performing MR imaging before surgery for primary hyperparathyroidism. Acta Chir Belg 113:112–122

    CAS  PubMed  Google Scholar 

  47. Stanisz GJ, Odrobina EE, Pun J et al (2005) T1, T2 relaxation and magnetization transfer in tissue at 3T. Magn Reson Med 54:507–512

    Article  PubMed  Google Scholar 

  48. Barth MM, Smith MP, Pedrosa I et al (2007) Body MR imaging at 3.0 T: understanding the opportunities and challenges. Radiographics 27:1445–1463

    Article  PubMed  Google Scholar 

  49. Reeder SB, Pineda AR, Wen Z et al (2005) Iterative decomposition of water and fat with echo asymmetry and least-squares estimation (IDEAL): application with fast spin-echo imaging. Magn Reson Med 54:636–644

    Article  PubMed  Google Scholar 

  50. Ma J, Singh SK, Kumar AJ et al (2004) T2-weighted spine imaging with a fast three-point Dixon technique: comparison with chemical shift selective fat suppression. J Magn Reson Imaging 20:1025–1029

    Article  PubMed  Google Scholar 

  51. Barger AV, DeLone DR, Bernstein MA et al (2006) Fat signal suppression in head and neck imaging using fast spin-echo IDEAL technique. AJNR Am J Neuroradiol 27:1292–1294

    CAS  PubMed  Google Scholar 

  52. Reeder SB, McKenzie CA, Pineda AR et al (2007) Water–fat separation with IDEAL gradient-echo imaging. J Magn Reson Imaging 25:644–652

    Article  PubMed  Google Scholar 

  53. Korosec FR, Frayne R, Grist TM et al (1996) Time-resolved contrast-enhanced 3D MR angiography. Magn Reson Med 36:345–351

    Article  CAS  PubMed  Google Scholar 

  54. Grayev AM, Perlman SB, Gentry LR (2012) Presurgical localization of parathyroid adenomas with magnetic resonance imaging at 3.0 T: an adjunct method to supplement traditional imaging. Ann Surg Oncol 19:981–989

    Article  PubMed  Google Scholar 

  55. Auffermann W, Guis M, Tavares NJ et al (1989) MR signal intensity of parathyroid adenomas: correlation with histopathology. AJR Am J Roentgenol 153:873–876

    Article  CAS  PubMed  Google Scholar 

  56. Wieneke JA, Smith A (2008) Parathyroid adenoma. Head Neck Pathol 2:305–308

    Article  PubMed Central  PubMed  Google Scholar 

  57. Busse RF, Brau AC, Vu A, Michelich CR et al (2008) Effects of refocusing flip angle modulation and view ordering in 3D fast spin echo. Magn Reson Med 60:640–649

    Article  PubMed Central  PubMed  Google Scholar 

  58. Israel GM, Hindman N, Hecht E et al (2005) The use of opposed-phase chemical shift MRI in the diagnosis of renal angiomyolipomas. AJR Am J Roentgenol 184:1868–1872

    Article  PubMed  Google Scholar 

  59. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. (2005) Endocr Pract 11(1):49–54

  60. Lubitz CC, Stephen AE, Hodin RA et al (2012) Preoperative localization strategies for primary hyperparathyroidism: an economic analysis. Ann Surg Oncol 13:4202–4209

    Article  Google Scholar 

  61. Cheung K, Wang TS, Farrokhyar F et al (2012) A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol 19:577–583

    Article  PubMed  Google Scholar 

  62. Kutler DI, Moquete R, Kazam E et al (2011) Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism. Laryngoscope 121:1219–1224

    Article  PubMed  Google Scholar 

  63. Chazen JL, Gupta A, Dunning A et al (2012) Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR 33:429–433

    Article  CAS  PubMed  Google Scholar 

  64. Hoang JK, Sung WK, Bahl M (2014) How to Perform Parathyroid 4D CT: tips and traps for technique and interpretation. Radiology 270:15–24

    Article  PubMed  Google Scholar 

  65. Mahajan A, Starker LF, Ghita M et al (2012) Parathyroid four-dimensional computed tomography: evaluation of radiation dose exposure during preoperative localization of parathyroid tumors in primary hyperparathyroidism. World J Surg 36:1335–1339

    Article  PubMed  Google Scholar 

  66. Numerow LW, Morita ET, Clark OH et al (1995) Hyperparathyroidism: a comparison of sestamibi scintigraphy, MRI, and ultrasonography. J Magn Reson Imaging 5:702–708

    Article  CAS  PubMed  Google Scholar 

  67. McDermott VG, Fernandez RJ, Meakem TJ 3rd et al (1996) Preoperative MR imaging in hyperparathyroidism: results and factors affecting parathyroid detection. AJR 166:705–710

    Article  CAS  PubMed  Google Scholar 

  68. Ernst O (2009) Hyperparathyroidism: CT and MR findings. J Radiol 90:409–412

    Article  CAS  PubMed  Google Scholar 

  69. Ghandur-Mnaymneh L, Kimura N (1984) The parathyroid adenoma: a histopathologic definition with a study of 172 cases of primary hyperparathyirodism. Am J Pathol 115:70–83

    PubMed Central  CAS  PubMed  Google Scholar 

  70. Genc H, Morita E, Perrier ND et al (2003) Differing histologic findings after bilateral and focused parathyroidectomy. J Am Coll Surg 196:535–540

    Article  PubMed  Google Scholar 

  71. Carlson D (2010) Parathyroid pathology hyperparathyroidism and parathyroid tumors. Arch Pathol Lab Med 134:1639–1644

    PubMed  Google Scholar 

  72. Turner HE, Harris AL, Melmed S et al (2013) Angiogenesis in endocrine tumors. Endocr Rev 24:600–632

    Article  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is prof. Carlo Catalano. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, observational study, performed at one institution.

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Authors and Affiliations

  1. Department of Radiological Sciences, Oncology and Pathology, Sapienza University, viale Regina Elena 324, 00161, Rome, Italy

    B. Sacconi, R. Argirò, Daniele Diacinti, A Iannarelli, M. Bezzi, V. Cipolla, C. De Felice & C. Catalano

  2. Department of Clinical Sciences, Sapienza University, viale del Policlinico 155, 00161, Rome, Italy

    C. Cipriani & S. Minisola

  3. Department of Clinical and Molecular Medicine, Sapienza University, via Grottarossa 1035, 00189, Rome, Italy

    D. Pisani

  4. Department of Radiological Sciences, Oncology and Pathology, Sapienza Università di Roma, V.le Regina Elena 324, 00161, Roma, Italy

    Daniele Diacinti

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  1. B. Sacconi
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  3. Daniele Diacinti
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Correspondence to Daniele Diacinti.

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Sacconi, B., Argirò, R., Diacinti, D. et al. MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization. Eur Radiol 26, 664–673 (2016). https://doi.org/10.1007/s00330-015-3854-5

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  • DOI: https://doi.org/10.1007/s00330-015-3854-5

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