Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Am J Otolaryngol. 2021 May-Jun;42(3):102907. doi: 10.1016/j.amjoto.2021.102907. Epub 2021 Jan 12.
To present the results of our implementation of a four-dimensional computed tomography- (4DCT) based parathyroid localization protocol for primary hyperparathyroidism at a safety net hospital.
We performed a retrospective review of all patients who underwent parathyroidectomy for primary hyperparathyroidism at Elmhurst Hospital Center from June 2016 - September 2019. Patients treated prior to the implementation of 4DCT during October 2018 served as historical controls for comparison. Imaging-related costs and hospital charges were obtained from the Radiology Department for each patient.
Forty-two patients underwent parathyroid surgery during the study period. Twenty patients had undergone 4DCT while 22 had nuclear medicine studies with or without ultrasonography. The sensitivity and specificity of 4DCT was 90.4% and 100% respectively, compared to 63% and 93.7% for nuclear imaging studies and 41% and 95% for ultrasound. The mean number of glands explored was significantly less in the 4DCT group, 1.8 ± 1.19 versus 2.77 ± 1.26 (p = 0.01). There was no increase in infrastructure or personnel costs associated with 4DCT implementation.
4DCT represents an increasingly common imaging modality for pre-operative parathyroid localization. Here we demonstrate that 4DCT is associated with a reduction in the number of glands explored and enables minimally invasive parathyroid surgery. 4DCT is a cost-effective and clinically sound localization study for parathyroid localization in an urban safety-net hospital.
介绍我们在一家社区医院实施基于四维 CT（4DCT）的甲状旁腺定位方案用于原发性甲状旁腺功能亢进的结果。
我们对 2016 年 6 月至 2019 年 9 月在埃尔姆赫斯特医院中心接受甲状旁腺切除术治疗原发性甲状旁腺功能亢进的所有患者进行了回顾性研究。在 2018 年 10 月实施 4DCT 之前接受治疗的患者作为比较的历史对照。每位患者的影像学相关费用和住院费用均从放射科获得。
研究期间有 42 例患者接受甲状旁腺手术。20 例患者接受了 4DCT，22 例患者接受了核医学研究，其中包括或不包括超声检查。4DCT 的敏感性和特异性分别为 90.4%和 100%，而核医学研究分别为 63%和 93.7%，超声检查分别为 41%和 95%。4DCT 组探查的腺体数量明显减少，平均为 1.8 ± 1.19 个，而核医学研究组为 2.77 ± 1.26 个（p = 0.01）。实施 4DCT 并未增加基础设施或人员成本。
4DCT 是术前甲状旁腺定位的一种越来越常见的影像学手段。在这里，我们证明 4DCT 与探查的腺体数量减少有关，并能实现微创甲状旁腺手术。4DCT 是城市社区医院甲状旁腺定位的一种具有成本效益和临床合理性的定位研究。
