Suh Yong Joon, Choi June Young, Kim Su-jin, Chun In Kook, Yun Tae Jin, Lee Kyu Eun, Kim Ji-hoon, Cheon Gi Jeong, Youn Yeo-Kyu
Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
Otolaryngol Head Neck Surg. 2015 Mar;152(3):438-43. doi: 10.1177/0194599814562195. Epub 2014 Dec 17.
The present study was designed to evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT).
Case series with expertized image review.
Tertiary care hospital.
A total of 38 patients were recruited for study, all of whom had undergone focused parathyroidectomy for single-lesion primary HPT between June 2011 and September 2013. In each patient, 3 imaging procedures were performed: cervical ultrasonography (US), 99mTc-sestamibi SPECT/CT (SeS), and 4D CT. Collective imaging data were blindly reviewed and compared.
4D CT outperformed US and SeS in terms of sensitivity (P=.27), specificity (P=.01), positive predictive value (PPV) (P<.01), negative predictive value (NPV) (P=.19), and accuracy (P<.01). In 7.9% (3/38) of patients, 4D CT provided specific anatomic information that was unaffordable by US and SeS. Localization by 4D CT correlated with tissue parathyroid hormone level (P=.02), maximum diameter (P=.01), and volume (P<.01) of abnormal parathyroid glands.
4D CT proved helpful in localizing target parathyroid glands of primary HPT that were missed by traditional imaging.
本研究旨在评估四维计算机断层扫描（CT）作为定位原发性甲状旁腺功能亢进症（HPT）中异常甲状旁腺的一种方法。
具有专业图像审查的病例系列。
三级医疗中心。
共招募了38例患者进行研究，所有患者均在2011年6月至2013年9月期间因单病灶原发性HPT接受了聚焦甲状旁腺切除术。每位患者均进行了3种成像检查：颈部超声（US）、99m锝-甲氧基异丁基异腈单光子发射计算机断层扫描/CT（SeS）和四维CT。对收集的成像数据进行盲法审查和比较。
四维CT在敏感性（P = 0.27）、特异性（P = 0.01）、阳性预测值（PPV）（P < 0.01）、阴性预测值（NPV）（P = 0.19）和准确性（P < 0.01）方面均优于超声和SeS。在7.9%（3/38）的患者中，四维CT提供了超声和SeS无法提供的特定解剖信息。四维CT定位与异常甲状旁腺的组织甲状旁腺激素水平（P = 0.02）、最大直径（P = 0.01）和体积（P < 0.01）相关。
四维CT有助于定位传统成像遗漏的原发性HPT的目标甲状旁腺。
