El Alam Raquelle, Hammer Mark M, Madan Rachna
Department of Radiology, Brigham and Women's Hospital, Boston, MA (R.E.A., M.M.H., R.M.); Harvard Medical School, Boston, MA (R.E.A., M.M.H., R.M.).
Department of Radiology, Brigham and Women's Hospital, Boston, MA (R.E.A., M.M.H., R.M.); Harvard Medical School, Boston, MA (R.E.A., M.M.H., R.M.).
Acad Radiol. 2025 Mar;32(3):1353-1359. doi: 10.1016/j.acra.2024.09.031. Epub 2024 Sep 28.
To evaluate whether parathyroid adenomas can be detected by thoracic radiologists on routine chest CT.
MATERIALS/METHODS: This retrospective study included patients with hyperparathyroidism evaluated by parathyroid scans and a control group with normal calcium. All had enhanced chest CT within 36 months prior to parathyroid imaging. Chest CTs were reviewed by 3 blinded thoracic radiologists. We report diagnostic accuracy for all positive findings and findings > 8 mm.
Our sample comprised 126 patients, 63 with confirmed hyperparathyroidism and 63 control patients; 6 parathyroid cases were excluded for being out of the field of view. Readers 1, 2, and 3 had sensitivity of 95%, 60%, and 35%, and specificity of 88%, 89%, and 97%, respectively. Specificity increased to 95%, 97%, and 98% when considering only findings larger than 8 mm. Review of false negative studies for reader 1 revealed 3 parathyroid adenomas visualized in retrospect. Review of the 7 false positive studies for reader 1 revealed candidate lesions in all of them attributed to exophytic thyroid nodules or lymph nodes. 90%, 67%, and 40% of the parathyroid adenoma patients had at least 1, 2, and 3 complications respectively. Most prevalent complications were nephrolithiasis (48%) and osteopenia (46%).
Routine contrast-enhanced chest CT can detect the majority of parathyroid adenomas with high specificity.
CLINICAL RELEVANCE/APPLICATION: Increasing awareness of parathyroid adenomas by chest radiologists allow for detection of enlarged parathyroid glands, diagnosing hyperparathyroidism before clinical presentation.
评估胸部放射科医生能否在常规胸部CT上检测出甲状旁腺腺瘤。
材料/方法：这项回顾性研究纳入了经甲状旁腺扫描评估的甲状旁腺功能亢进患者以及血钙正常的对照组。所有患者在甲状旁腺成像前36个月内均进行了增强胸部CT检查。3名不知情的胸部放射科医生对胸部CT进行了评估。我们报告了所有阳性发现及直径>8mm的发现的诊断准确性。
我们的样本包括126例患者，其中63例确诊为甲状旁腺功能亢进，63例为对照患者；6例甲状旁腺病例因不在视野范围内被排除。读者1、2和3的敏感度分别为95%、60%和35%，特异度分别为88%、89%和97%。仅考虑直径大于8mm的发现时，特异度分别提高到95%、97%和98%。对读者1的假阴性研究进行回顾后发现，回顾性观察到3例甲状旁腺腺瘤。对读者1的7例假阳性研究进行回顾后发现，所有病例中的候选病变均归因于甲状腺外生性结节或淋巴结。分别有90%、67%和40%的甲状旁腺腺瘤患者至少有1种、2种和3种并发症。最常见的并发症是肾结石（48%）和骨质减少（46%）。
常规对比增强胸部CT能够以高特异度检测出大多数甲状旁腺腺瘤。
临床意义/应用：胸部放射科医生提高对甲状旁腺腺瘤的认识，有助于检测到增大的甲状旁腺，在临床表现出现之前诊断甲状旁腺功能亢进。
