Division of General Surgery, London Health Sciences Center, London, ON, Canada.
Division of General Surgery, Jersey Shore University Medical Center, Neptune City, NJ, USA.
Ann Surg Oncol. 2018 May;25(5):1403-1409. doi: 10.1245/s10434-018-6367-z. Epub 2018 Feb 26.
Recurrent primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localizing a hyperfunctioning gland. Although several imaging modalities are available for preoperative localization, 4D-CT is increasingly utilized for its ability to locate both smaller and previously unlocalized lesions. Currently, there is a paucity of data evaluating the utility of 4D-CT in the reoperative setting compared with ultrasound (US) and sestamibi. We aimed to determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent PHPT.
We performed a retrospective review of prospectively collected data from a tertiary-care hospital, and identified 58 patients who received preoperative 4D-CT with US and/or sestamibi between May 2008 and March 2016. Data regarding the size, shape, and number of parathyroid lesions were collected for each patient.
A total of 62 lesions were identified intraoperatively among the 58 patients (6 with multigland disease) included in this investigation. 4D-CT missed 13 lesions identified intraoperatively, compared with 32 and 22 lesions missed by US and sestamibi, respectively. Sensitivity for correct lateralization of culprit lesions was 77.4% for 4D-CT, 38.5% for US, and 46% for sestamibi. 4D-CT was superior in lateralizing adenomas (49/62) compared with US (20/52; p < 0.001) and sestamibi (18/47; p < 0.001). The overall cure rate (6-month postoperative calcium < 10.7 mg/dL) was 89.7%. All patients with lesions correctly lateralized by 4D-CT were cured at 6 months.
4D-CT localized parathyroid adenomas with higher sensitivity among patients with recurrent or persistent PHPT compared with sestamibi or US-based imaging.
复发性原发性甲状旁腺功能亢进症 (PHPT) 在定位功能亢进的腺体时存在诊断挑战。尽管有多种影像学方法可用于术前定位，但 4D-CT 因其能够定位更小和以前未定位的病变而越来越多地被应用。目前，与超声 (US) 和 sestamibi 相比，评估 4D-CT 在复发性或持续性 PHPT 中的应用价值的数据很少。我们旨在确定 4D-CT 在定位复发性或持续性 PHPT 中的甲状旁腺腺瘤中的敏感性。
我们对一家三级保健医院前瞻性收集的数据进行了回顾性分析，并确定了 58 例在 2008 年 5 月至 2016 年 3 月期间接受术前 4D-CT 联合 US 和/或 sestamibi 的患者。收集每位患者甲状旁腺病变的大小、形状和数量数据。
在纳入本研究的 58 例患者（6 例患有多腺体疾病）中，共有 62 例病变在术中被发现。与 US 和 sestamibi 相比，4D-CT 分别漏诊了 13 个术中发现的病变，分别漏诊了 32 个和 22 个病变。4D-CT 对可疑病变的正确侧位的敏感性为 77.4%，US 为 38.5%，sestamibi 为 46%。4D-CT 在侧位定位腺瘤（49/62）方面优于 US（20/52；p<0.001）和 sestamibi（18/47；p<0.001）。总的治愈率（术后 6 个月血钙<10.7mg/dL）为 89.7%。所有 4D-CT 正确定位的病变患者在 6 个月时均被治愈。
与基于 sestamibi 或 US 的成像相比，4D-CT 在复发性或持续性 PHPT 患者中定位甲状旁腺腺瘤的敏感性更高。
