Department of Endocrinology, Seth GS Medical College and KEM Hospital, Parel, Mumbai India.
Department of Endocrinology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India.
Ann Endocrinol (Paris). 2023 Aug;84(4):446-453. doi: 10.1016/j.ando.2023.03.001. Epub 2023 Mar 10.
Childhood and adolescent primary hyperparathyroidism (PHPT) is a rare disease caused by single adenomas in 65-94% of patients. In this patient group, there is no data on computed tomography (CT) for pre-operative parathyroid localization that may facilitate focused parathyroidectomy.
Two radiologists reviewed dual-phase (nonenhanced and arterial) CT images of twenty-three operated children and adolescents [20:single-gland disease(SGD), 3:multi-glandular disease(MGD)] with proven histopathological PHPT. Percentage arterial enhancement (PAE) was calculated as [100*{arterial-phase Hounsfield unit (HU)-nonenhanced phase HU}/nonenhanced HU] of the parathyroid lesion(s), thyroid, and lymph node.
Dual-phase CT lateralized 100%, localized to the correct quadrant/site 85% SGD (including 3/3 ectopic), and identified 1/3 MGD. PAE (cutoff ≥ 112.3%) was sensitive (91.3%) and specific (99.5%) in distinguishing parathyroid lesions from local mimics (P<0.001). The average effective dose was 3.16±1.01mSv, comparable to the planar/single photon emission CT (SPECT) Technetium 99m(Tc)-sestamibi and choline positron emission tomography (PET)/CT scans. Solid-cystic morphology identified in 4 patients harboring pathogenic germline variants (3:CDC73, 1:CASR) may serve as a radiological clue to molecular diagnosis. Nineteen out of 20 (95%) patients with SGD who had undergone single gland resection based on pre-operative CT findings were in remission over a median follow-up of 18 months.
As most children/adolescents with PHPT have SGD, dual-phase CT protocols which reduce the effective radiation dose with high localization sensitivity for single parathyroid lesions may be a sustainable pre-operative imaging modality in this patient group.
儿童和青少年原发性甲状旁腺功能亢进症（PHPT）是一种罕见疾病，65-94%的患者由单发腺瘤引起。在这组患者中，没有关于术前甲状旁腺定位的计算机断层扫描（CT）数据，这可能有助于进行针对性甲状旁腺切除术。
两名放射科医生回顾了 23 名经手术治疗的儿童和青少年[20 例：单腺体疾病（SGD），3 例：多腺体疾病（MGD）]的双期（非增强和动脉期）CT 图像，这些患者的 PHPT 均经组织病理学证实。计算甲状旁腺病变（s）、甲状腺和淋巴结的动脉期增强百分比（PAE）为[100*{动脉期 HU-非增强期 HU}/非增强期 HU}]。
双期 CT 侧位定位准确率为 100%，对 SGD 的定位准确率为 85%（包括 3/3 例异位），MGD 的定位准确率为 33%。PAE（截断值≥112.3%）在鉴别甲状旁腺病变与局部类似物方面具有较高的敏感性（91.3%）和特异性（99.5%）（P<0.001）。平均有效剂量为 3.16±1.01mSv，与平面/单光子发射计算机断层扫描（SPECT）锝 99m（Tc）-甲氧基异丁基异腈和胆碱正电子发射断层扫描（PET）/CT 扫描相当。在 4 名携带致病性种系变异的患者中发现的实性-囊性形态（3 例：CDC73，1 例：CASR）可能成为分子诊断的影像学线索。在基于术前 CT 结果进行单腺体切除的 20 例 SGD 患者中，19 例（95%）在中位随访 18 个月后处于缓解状态。
由于大多数 PHPT 儿童和青少年患有 SGD，因此对于单发性甲状旁腺病变具有高定位敏感性且可降低有效辐射剂量的双期 CT 方案可能是该患者群体中可持续的术前影像学检查方法。
