4D-Dynamic 对比增强 MRI 在原发性甲状旁腺功能亢进症患者术前定位中的应用。
4D-Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism.
机构信息
From the Departments of Medical Imaging (J.L.B., V.P., K.J.J.)
From the Departments of Medical Imaging (J.L.B., V.P., K.J.J.).
出版信息
AJNR Am J Neuroradiol. 2020 Mar;41(3):522-528. doi: 10.3174/ajnr.A6482. Epub 2020 Mar 12.
BACKGROUND AND PURPOSE
Our aim was to test the hypothesis that our recently introduced 4D-dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation.
MATERIALS AND METHODS
Inclusion criteria were the following: 1) confirmed biochemical diagnosis of primary hyperparathyroidism, 2) preoperative 4D-dynamic contrast-enhanced MR imaging, and 3) surgical cure with >50% decrease in serum parathyroid hormone intraoperatively. 4D-dynamic contrast-enhanced studies were reviewed independently by 2 neuroradiologists to identify the side, quadrant, and number of abnormal glands, and compared with surgical and pathologic results.
RESULTS
Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease (9 with double-gland hyperplasia; 3 with 3-gland hyperplasia; and 5 with 4-gland hyperplasia). Interobserver agreement (κ) for the side (right versus left) was 0.92 for single-gland disease and 0.70 for multigland disease. Interobserver agreement for the quadrant (superior versus inferior) was 0.70 for single-gland disease and 0.69 for multigland disease. For single-gland disease, the gland was correctly located in 34/37 (92%) patients, with correct identification of the side in 37/37 (100%) and the quadrant in 34/37 (92%) patients. For multigland disease, the glands were correctly located in 35/47 (74%) patients, with correct identification of the side in 35/47 (74%) and the quadrant in 36/47 (77%).
CONCLUSIONS
The proposed high spatial and temporal resolution 4D-dynamic contrast-enhanced MR imaging provides excellent diagnostic performance for preoperative localization in primary hyperparathyroidism, with correct gland localization of 92% for single-gland disease and 74% in multigland disease, superior to 4D-CT studies.
背景与目的
我们的目的是检验假设，即我们最近引入的高空间和时间分辨率的 4D 动态对比增强磁共振成像在原发性甲状旁腺功能亢进的术前腺体定位方面与 4D-CT 具有同等的准确性，而无需暴露于电离辐射。
材料与方法
纳入标准如下：1）确认原发性甲状旁腺功能亢进的生化诊断，2）术前进行 4D 动态对比增强磁共振成像，3）术中甲状旁腺激素水平下降>50%而治愈。由 2 名神经放射科医生独立回顾 4D 动态对比增强研究，以确定异常腺体的侧别、象限和数量，并与手术和病理结果进行比较。
结果
54 例患者符合纳入标准：37 例为单腺疾病，17 例为多腺疾病（9 例双腺增生；3 例 3 腺增生；5 例 4 腺增生）。单腺疾病侧别（右侧与左侧）的观察者间一致性（κ）为 0.92，多腺疾病为 0.70。单腺疾病象限（上象限与下象限）的观察者间一致性为 0.70，多腺疾病为 0.69。对于单腺疾病，37/37（100%）例中的腺体被正确定位，37/37（100%）例中的侧别和 34/37（92%）例中的象限被正确识别。对于多腺疾病，47/47（100%）例中的腺体被正确定位，35/47（74%）例中的侧别和 36/47（77%）例中的象限被正确识别。
结论
提出的高空间和时间分辨率 4D 动态对比增强磁共振成像为原发性甲状旁腺功能亢进的术前定位提供了出色的诊断性能，单腺疾病的正确腺体定位率为 92%，多腺疾病为 74%，优于 4D-CT 研究。
Zotero 插件