Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
Hormones (Athens). 2021 Sep;20(3):499-506. doi: 10.1007/s42000-020-00205-x. Epub 2020 May 13.
The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and Tc-scintigraphy (sestamibi) are currently considered the 'gold standard'. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients.
An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging.
All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78-94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53-76]; p < 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64-96) versus US and sestamibi (57% [95% CI 34-77]; p = 0.016). For adenomas < 1.0 g (n = 36; 48%), the accuracy of CT was 81% (95% CI 64-91) compared with 62% (95% CI 44-77) for US and sestamibi (p = 0.04). The correct preoperative diagnosis of multiglandular disease (n = 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14-73]) and US and CT (50% [95% CI 20-80]) (p > 0.99).
The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.
微创甲状旁腺切除术（MIP）的成功依赖于对异常甲状旁腺的准确定位。目前，超声（US）和 Tc 闪烁扫描（锝-99m 甲氧基异丁基异腈）的一致性发现被认为是“金标准”。计算机断层扫描（CT）最近也已用于术前规划。我们旨在评估 CT 在定位此类患者异常甲状旁腺中的准确性。
对 2017 年至 2019 年期间在我们中心作为一线影像学检查接受颈部 US 和 CT 检查的 75 例原发性甲状旁腺功能亢进症（PHPT）患者进行了审核。
所有 75 例患者均接受了 US 和 CT 检查，其中 54 例（72.0%）还进行了锝-99m 甲氧基异丁基异腈检查。单独 CT 检查可在所有患者中识别出潜在的靶标，其中 63 例（84.0%）的定位正确。US 和 CT 的总体联合灵敏度为 88%（95%CI 78-94），高于 US 和锝-99m 甲氧基异丁基异腈的联合灵敏度（65%[95%CI 53-76]；p<0.001）。21 例（28.0%）患者存在异位腺体，US 和 CT 的灵敏度为 86%（95%CI 64-96），而 US 和锝-99m 甲氧基异丁基异腈的灵敏度为 57%（95%CI 34-77）；p=0.016）。对于<1.0g 的腺瘤（n=36；48%），CT 的准确性为 81%（95%CI 64-91%），而 US 和锝-99m 甲氧基异丁基异腈的准确性为 62%（95%CI 44-77%）（p=0.04）。术前正确诊断多腺体疾病（n=9；12%）似乎最为困难，US 和锝-99m 甲氧基异丁基异腈（40%[95%CI 14-73%]）和 US 和 CT（50%[95%CI 20-80%]）的准确性相似（p>0.99）。
US 和 CT 的联合使用能够正确识别 88%患者的异常甲状旁腺的位置，与 US 和锝-99m 甲氧基异丁基异腈相比，具有更高的诊断准确性，尤其是对较小的和异位的腺瘤。这一发现表明，对于考虑接受微创甲状旁腺切除术的 PHPT 患者，US 和 CT 可被视为一线影像学检查方法。
