Surgery Clinic of Tartu University Hospital, 50406 Tartu, Estonia.
Faculty of Medicine, University of Tartu, 50406 Tartu, Estonia.
Medicina (Kaunas). 2023 Aug 3;59(8):1415. doi: 10.3390/medicina59081415.
Ultrasonography (US) and the 99mTc-sestamibi parathyroid scan (SPS) may have suboptimal accuracy when detecting the localization of enlarged parathyroid gland(s) (PTG). Therefore, the more accurate four-dimensional computed tomography scan (4D-CT) has been employed for PTG imaging. Currently, there is a paucity of data evaluating the utility of 4D-CT in low caseload settings. To evaluate the impact of PTG imaging, using 4D-CT in conjunction with its intraoperatively displayed results, on the outcomes of surgical PTX. A single-center retrospective analysis of surgically treated patients with pHPT from 01/2010 to 01/2021 was conducted. An evaluation of the impact of the preoperative imaging modalities on the results of surgical treatment was carried out. During the study period, 290 PTX were performed; 45 cases were excluded due to surgery for secondary, tertiary or recurrent HPT, or due to the use of alternative imaging techniques. The remaining 245 patients were included in the study. US was carried out for PTG imaging in 236 (96.3%), SPS in 93 (38.0%), and 4D-CT in 52 patients (21.2%). The use of 4D-CT was associated with a significantly higher rate of successful localization of enlarged PTG (49 cases, 94.2%) compared to US and SPS (74 cases, 31.4%, and 54 cases, 58.1%, respectively). We distinguished between three groups of patients based on preoperative imaging: (1) PTG lateralization via US or SPS in 106 (43.3%) cases; (2) precise localization of PTG via 4D-CT in 49 (20.0%) patients; and (3) in 90 cases (36.7%), PTG imaging failed to localize an enlarged gland. The group of 4D-CT localization had significantly shorter operative time, lower rate of simultaneous thyroid resections, as well as lower rate of removal of ≥2 PTG, compared to the other groups. The 4D-CT imaging was also associated with the lowest perioperative morbidity and with the lowest median PTH in the one month follow-up; however, compared to the other groups, these differences were statistically not significant. The implementation of 4D-CT (since 01/2018) was associated with a decrease in the need for redo surgery (from 11.5% to 7.3%) and significantly increased the annual case load of PTX at our institution (from 15.3 to 41.0) compared to the period before 4D-CT diagnostics. 4D-CT imaging enabled to precisely locate almost 95% of enlarged PTG in patients with pHPT. Accurate localization and intraoperatively displayed imaging results are useful guides for surgeons to make PTX a faster and safer procedure in a low-volume center.
超声（US）和 99mTc-甲氧基异丁基异腈甲状旁腺扫描（SPS）在检测增大的甲状旁腺（PTG）的定位时可能准确性不足。因此，更准确的四维计算机断层扫描（4D-CT）已被用于 PTG 成像。目前，评估低病例量环境中 4D-CT 应用价值的数据很少。本研究旨在评估使用 4D-CT 结合其术中显示结果对甲状旁腺全切除术（PTX）治疗结果的影响。对 2010 年 1 月至 2021 年 1 月接受手术治疗的 pHPT 患者进行了单中心回顾性分析。评估了术前影像学检查对手术治疗结果的影响。研究期间共进行了 290 例 PTX，由于手术治疗继发性、三级或复发性 HPT 或使用替代影像学技术，排除了 45 例。剩余的 245 例患者纳入研究。236 例（96.3%）进行了 PTG 成像超声检查，93 例（38.0%）进行了 SPS，52 例（21.2%）进行了 4D-CT。与 US 和 SPS 相比，使用 4D-CT 显著提高了定位增大的 PTG 的成功率（49 例，94.2%比 74 例，31.4%和 54 例，58.1%）。我们根据术前影像学检查将患者分为三组：（1）106 例（43.3%）通过 US 或 SPS 进行 PTG 侧位定位；（2）49 例（20.0%）通过 4D-CT 进行精确定位；（3）90 例（36.7%）PTG 影像学检查未能定位增大的腺体。4D-CT 定位组的手术时间明显缩短，甲状腺同时切除率较低，同时切除≥2 个 PTG 的比例也较低。与其他组相比，4D-CT 成像还与最低的围手术期发病率和术后一个月最低的中位数 PTH 相关；然而，与其他组相比，这些差异没有统计学意义。自 2018 年 1 月以来，4D-CT 的实施与再次手术的需求减少（从 11.5%降至 7.3%）以及我院 PTX 的年度病例数显著增加（从 15.3 例增加到 41.0 例）相关。4D-CT 成像能够精确定位 pHPT 患者近 95%的增大 PTG。准确的定位和术中显示的影像学结果可帮助外科医生在低容量中心更快、更安全地进行 PTX。
