Effectiveness of 4D-CT in preoperative localization of primary hyperparathyroid lesions in an Asian population

Congress:

ECR 2019

Poster Number:

C-0206

Type:

Scientific Exhibit

Keywords:

Head and neck, Thyroid / Parathyroids, CT, Audit and standards, Endocrine disorders

Authors:

L. M. Loy¹, S. W. Kheok², L. E. McAdory²; ¹SINGAPORE, SINGAPORE/SG, ²Singapore/SG

DOI:

10.26044/ecr2019/C-0206

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-0206

Fig. 1: Sestamibi scan of the neck did not identify any suspicious parathyroid adenoma.

Fig. 2: Non contrast phase of CT neck

Fig. 3: Arterial phase of CT neck

Fig. 4: Venous phase of CT neck

Aims and objectives

Primary hyperparathyroidism (PHP) is characterized by hypercalcemia caused by 1 or more hyperfunctioning parathyroid glands. Single gland parathyroid adenomas are the cause in 75-85% of cases, with the remaining cases due to double gland lesions and hyperplasia. [1, 2] Definitive treatment is surgical resection of the hyperfunctioning glands. Accurate pre-operative localization, usually with sestamibi and ultrasound (US) scans, allows the resection to be done using focused or unilateral parathyroidectomy instead of 4-gland exploration. [2, 3] 4-dimensional computed tomography (4D CT) has been reported to be...

Methods and materials

In this audit, we identified consecutive patients who were referred to the Department of Diagnostic Radiology at Singapore General Hospital for 4D CT scans from April 2015 to August 2018 after initial sestamibi and US scans. We included patients who underwent surgical resection and whose pathology results were available. In addition, we only included patients who were clinically diagnosed with primary hyperparathyroidism, and excluded patients with history of renal failure or secondary hyperparathyroidism. 4D CT-imaging was conducted using a Siemens SOMATOM Definition CT scanner with...

Results

14 patients (11 Chinese, 2 Malays, 1 Indian) met our inclusion criteria. The mean age of the patients was 60.1 ± 9.7 years, with 78.6% of the patients female. All 14 patients had elevated serum PTH and calcium levels prior to surgery. Sestamibi and US results were negative and discordant in 3 and 5 patients respectively. 4 patients had concordant, positive sestamibi and US results but were referred for 4D CT scan for further confirmation. 2 patients did not have both sestamibi and US results...

Conclusion

4D CT is effective in localizing abnormal parathyroid glands in Asian patients with primary hyperparathyroid lesions. In particular, 4D-CT can localize lesions in patients with discordant or negative sestamibi and ultrasound findings, enabling the patients to undergo less invasive surgery.

Personal information

References

1. Fraser, W.D., Hyperparathyroidism. Lancet, 2009. 374(9684): p. 145-58. 2. Lubitz, C.C., et al., Accuracy of 4-dimensional computed tomography in poorly localized patients with primary hyperparathyroidism. Surgery, 2010. 148(6): p. 1129-37; discussion 1137-8. 3. Eslamy, H.K. and H.A. Ziessman, Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics, 2008. 28(5): p. 1461-76. 4. Rodgers, S.E., et al., Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery, 2006. 140(6): p. 932-40; discussion 940-1. 5. Eichhorn-Wharry, L.I., A.M. Carlin, and G.B....