Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
Eur J Radiol. 2021 May;138:109625. doi: 10.1016/j.ejrad.2021.109625. Epub 2021 Mar 5.
Minimally invasive parathyroid surgery is the standard of care in patients with Primary Hyperparathyroidism (PHPT) which requires accurate preoperative localization. Of all the available imaging modalities, 4DCT is considered the best modality for localization, however it entails the risk of ionizing radiation. To circumvent this 4DMRI was evaluated for parathyroid lesion localization.
To evaluate and compare the accuracy of 4DCT and 4DMRI in the localization of parathyroid Lesions.
In this ethically approved observational diagnostic study, 135 patients (age range: 10-75 years, male: female ratio - 1:2.1) with clinically and biochemically suspected PHPT were recruited. Of these, 56 patients underwent both 4DCT and 4DMRI. Six patients with positive imaging who didn't undergo surgery were excluded. A total of 50 patients with 61 proven parathyroid lesions were included for analysis. 48 patients had surgical and histopathological findings for the confirmation of imaging findings.
Both 4DCT and 4DMRI correctly detected 59/61 lesions in 48 patients. There was one false positive and two true negatives. In addition, 2 (3.22 %) lesions which were not detected by 4DCT and 4DMRI were found on surgery. The sensitivity of both 4DCT and 4DMRI was 96.7 %; specificity was 66.6 % and accuracy was 95.2 %.
4DMRI and 4DCT had similar accuracy for the detection of parathyroid lesions. However, 4DMRI has the advantage of lack of exposure to ionizing radiation, which can be beneficial in younger patients.
微创甲状旁腺手术是原发性甲状旁腺功能亢进症（PHPT）患者的标准治疗方法，需要准确的术前定位。在所有可用的成像方式中，4DCT 被认为是定位的最佳方式，但它存在电离辐射的风险。为了规避这一风险，评估了 4D-MRI 用于甲状旁腺病变的定位。
评估和比较 4DCT 和 4D-MRI 对甲状旁腺病变定位的准确性。
在这项经过伦理批准的观察性诊断研究中，招募了 135 名（年龄范围：10-75 岁，男女比例为 1:2.1）具有临床和生化可疑 PHPT 的患者。其中，56 名患者同时接受了 4DCT 和 4D-MRI 检查。排除了 6 名影像学阳性但未接受手术的患者。共有 50 名患者的 61 个证实的甲状旁腺病变被纳入分析。48 名患者接受了手术和组织病理学检查，以确认影像学发现。
4DCT 和 4D-MRI 均正确检测到 48 名患者中的 59/61 个病变。有一个假阳性和两个真阴性。此外，在手术中还发现了 2 个（3.22%）4DCT 和 4D-MRI 未检测到的病变。4DCT 和 4D-MRI 的灵敏度均为 96.7%；特异性为 66.6%，准确性为 95.2%。
4D-MRI 和 4DCT 对甲状旁腺病变的检测具有相似的准确性。然而，4D-MRI 具有缺乏电离辐射暴露的优势，这在年轻患者中可能是有益的。
