Preoperative localisation of parathyroid adenomas (PAs) is critical to successful minimally invasive parathyroidectomy. Ultrasound and sestamibi scintigraphy remain the primary imaging modalities but four dimensional CT (4DCT) has gained popularity, often after alternative modalities have failed. Surgical approach for parathyroid gland resection has changed from bilateral neck exploration to minimally invasive parathyroidectomy with shorter operating times and reduced complications.Recently, 4DCT is being used for difficult cases when the gland has not been demonstrated by sestamibi or ultrasound. The fourth dimension of 4D CT is time,...

This was a retrospective study of 34 patients in GGC health board who underwent preoperative 4DCT, sestamibi nuclear medicine scan and ultrasound between May 2016 and December 2018. Patients were initially identified using a keyword function of “parathyroid” on hospital RIS. The clinical database was evaulatedto exclude patients that did not have surgery. Successful localisation was determined on the basis of gland location denoted in radiological reports, operative notes and pathological confirmation.

24/34 (71%) lesions were pathologically confirmed as parathyroid adenomas. Other diagnoses included gland hyperplasia, ectopic thyroid tissue and microcarcinomas. 72% of 4DCT scans were performed with 4 phases, 28% with 3 phases. 4DCT correctly identified 21 out of 24 parathyroid adenomas in our cohort of 34 patients that had surgery. 4DCT had sensitivity of 88% (21/(21+3) = 88%). 4DCT correctly identified adenoma in 6 patients after they were not identifiedon alternative imaging. 4DCT missed only three lesions identified intraoperatively,
 compared with 13 and 6 missed...

4DCT is invaluable in the pre-operative assessment of parathyroid adenomas. The multiplanar reconstruction capabilities offered by this modality provide superior spatial information necessary for planning and safe execution of successful parathyroid surgery. In our study, 4DCT sensitivity was 88% for parathyroid adenoma detection, similar to other large published studies. Sensitivity of 4DCT was higher than ultrasound (43%) and sestamibi with SPECT (70%). This high sensitivity of 4DCT may provide a beneficial role for initial diagnostic assessment of parathyroid adenoma with 4DCT rather than ultrasound or...

S. L. Macpherson; Glasgow/UK - nothing to disclose J. Levens; Glasgow/UK - nothing to disclose C. Cameron; Glasgow/UK - nothing to disclose M. A. Hunter; Glasgow/UK - nothing to disclose

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