Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
AJR Am J Roentgenol. 2011 Jan;196(1):61-5. doi: 10.2214/AJR.10.4459.
The objective of our study was to evaluate the accuracy of dynamic contrast-enhanced 4D MDCT in the preoperative identification of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT) and a history of failed surgery or unsuccessful localization on standard imaging.
Thirty-four patients with PHPT underwent 4D CT. Retrospective blinded review of the 4D CT examinations was performed by three radiologists for the presence and location of a suspected parathyroid adenoma or adenomas. At the time of the study, 25 patients underwent surgical exploration after 4D CT. Twenty patients had solitary parathyroid adenomas, two patients had two adenomas resected, two patients did not have an adenoma, and one patient had mild four-gland hyperplasia. One patient did not have PHPT on repeat serum biochemistry. Surgical and pathology reports, adenoma enhancement, and biochemical and clinical follow-up were reviewed. Data were compared with 4D CT interpretations and interobserver reliability was calculated.
The mean sensitivity and specificity of the three readers for the precise CT localization of adenomas was 82% (range, 79-88%) and 92% (range, 75-100%), respectively. Overall interobserver reliability was excellent (κ = 0.70; range, κ = 0.60-0.79). All adenomas resected at surgery showed a biochemical response and clinical response. The mean densities of the confirmed adenomas were 41, 128, 138, and 109 HU at 0, 30, 60, and 90 seconds, respectively. Level II lymph nodes identified in 10 patients showed significantly less enhancement at 30 (p = 0.0001) and 60 (p = 0.006) seconds compared with surgically proven adenomas.
Occult parathyroid adenoma shows characteristic early enhancement. In this subset of patients, 4D CT may improve surgical outcomes and decrease morbidity.
本研究旨在评估动态对比增强 4D MDCT 在术前识别原发性甲状旁腺功能亢进症（PHPT）患者甲状旁腺瘤中的准确性，这些患者既往手术失败或标准影像学定位不成功。
34 例 PHPT 患者行 4D CT 检查。3 名放射科医生对 4D CT 检查进行回顾性盲法分析，以评估可疑甲状旁腺瘤或腺瘤的存在和位置。在研究时，25 例患者在 4D CT 后接受了手术探查。20 例患者为单发甲状旁腺瘤，2 例患者为切除 2 个腺瘤，2 例患者无腺瘤，1 例患者为轻度四腺增生。1 例患者重复血清生化检查后未发现 PHPT。对手术和病理报告、腺瘤强化程度以及生化和临床随访进行了回顾。将数据与 4D CT 结果进行比较，并计算了观察者间的可靠性。
3 位读者对腺瘤的精确 CT 定位的平均敏感度和特异度分别为 82%（79%～88%）和 92%（75%～100%）。观察者间的总体可靠性为极好（κ=0.70；κ 值范围为 0.60～0.79）。所有在手术中切除的腺瘤均表现出生化和临床缓解。经手术证实的腺瘤在 0、30、60 和 90 秒时的平均密度分别为 41、128、138 和 109 HU。在 10 例患者中识别出的 II 级淋巴结在 30 秒（p=0.0001）和 60 秒（p=0.006）时的强化程度明显低于经手术证实的腺瘤。
隐匿性甲状旁腺瘤表现出特征性的早期强化。在这部分患者中，4D CT 可能改善手术结果并降低发病率。
