Hairston Hayden, Gardner James Reed, Gibson Anna Celeste, Wright Courtney, Small Mariah, King Deanne, Fitzgerald Ryan, Spencer Horace J, Bodenner Donald L, Stack Brendan C
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Radiology Consultants of Little Rock, Little Rock, AR, USA.
Gland Surg. 2024 Aug 31;13(8):1459-1468. doi: 10.21037/gs-24-141. Epub 2024 Aug 28.
Pre-operative imaging is a well-established practice for managing hyperparathyroidism with the plan for excision; however, there is a paucity of information regarding the success rate of concordant imaging studies. Our goal was to compare the accuracy (sensitivity) of four-dimensional computed tomography (4DCT) and ultrasound (US) when predicting the side and quadrant of parathyroid lesions, confirmed with surgical location (from a single surgeon).
A retrospective review of 437 patients from a single surgeon undergoing parathyroidectomy from December 2013 to January 2020 at an academic medical center was performed. Masses >5 mm in dimension in eutopic parathyroid locations were identified as possible parathyroid lesions on 4DCT. A unique codified system was utilized to accurately record imaging results for each modality and compared to surgical findings.
Four hundred and thirty-seven patients underwent parathyroid surgery, of those 431 underwent 4DCT, 413 underwent US, and 408 underwent both. 4DCT accurately lateralized lesions in 319 (74.0%; N=431). US lateralized lesions in 265 (64.2%; N=413). The sensitivity for lateralization was 81.2% and 69.9% for 4DCT and US, respectively.
4DCT and US identify the majority of parathyroid lesions. 4DCT outperformed US in lateralization yet both modalities remain useful and are complimentary in planning for successful parathyroidectomy. Newer imaging approaches such as F-choline positron emission tomography/computed tomography (PET/CT) and artificial intelligence as an augmentation to imaging review may play in role to identify parathyroid adenomas/hyperplasia, but their roles have yet to be clearly defined.
术前成像对于甲状旁腺功能亢进症切除手术计划的制定是一种成熟的做法；然而，关于一致成像研究成功率的信息却很匮乏。我们的目标是比较四维计算机断层扫描（4DCT）和超声（US）在预测甲状旁腺病变的侧别和象限方面的准确性（敏感性），并通过手术定位（由单一外科医生进行）来确认。
对2013年12月至2020年1月在一家学术医疗中心由单一外科医生进行甲状旁腺切除术的437例患者进行回顾性研究。在4DCT上，将位于正常甲状旁腺位置且直径>5mm的肿块确定为可能的甲状旁腺病变。采用独特的编码系统准确记录每种检查方式的成像结果，并与手术结果进行比较。
437例患者接受了甲状旁腺手术，其中431例进行了4DCT检查，413例进行了超声检查，408例同时进行了这两种检查。4DCT准确确定病变侧别的有319例（74.0%；N = 431）。超声确定病变侧别的有265例（64.2%；N = 413）。4DCT和超声侧别判断的敏感性分别为81.2%和69.9%。
4DCT和超声能识别大多数甲状旁腺病变。在侧别判断方面，4DCT优于超声，但两种检查方式在成功的甲状旁腺切除手术规划中仍然有用且互为补充。诸如F-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）和人工智能等更新的成像方法作为成像检查的辅助手段，可能在识别甲状旁腺腺瘤/增生中发挥作用，但其作用尚未明确界定。
