Bunch Paul M, Hiatt Kevin D, Rigdon Joseph, Lenchik Leon, Gorris Matthew A, Randle Reese W
Department of Radiology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC.
AJR Am J Roentgenol. 2025 Feb;224(2):e2432031. doi: 10.2214/AJR.24.32031. Epub 2024 Dec 4.
Primary hyperparathyroidism (PHPT) is underdiagnosed. Opportunistic imaging-based parathyroid gland assessment is a proposed strategy for identifying patients at increased risk of undiagnosed PHPT. However, whether this approach is likely to identify individuals with clinically significant disease is unknown. This study's objective was to assess for associations of the presence of an enlarged parathyroid gland on contrast-enhanced CT with clinical outcomes causally related to PHPT. This retrospective cohort study included patients 18 years old or older with at least one contrast-enhanced chest or neck CT examination performed from January 2012 to December 2012, at least one noncontrast CT examination covering the chest or neck region without a date restriction, and at least one clinical encounter in the health system from January 2022 to December 2022. A neuroradiologist reviewed the CT examinations to determine the presence versus absence of an enlarged parathyroid gland on the 2012 study. Patient demographics, serum calcium results, and diagnosis codes for clinical outcomes causally related to PHPT were extracted from the EHR. Calcium results and diagnosis codes were classified as preexisting if documented before and as incident if documented after the 2012 contrast-enhanced CT examination. The cohort included 1198 patients (593 men and 605 women; mean age, 51.6 years), of whom 43 (3.6%) were assessed as having an enlarged parathyroid gland on the 2012 contrast-enhanced CT examination. PHPT was diagnosed in 16.3% of patients with, versus 0.3% of patients without, an enlarged parathyroid gland ( < .001). After adjustment for age, sex, race, and ethnicity, the presence of an enlarged parathyroid gland on contrast-enhanced CT was associated with significantly increased odds of preexisting nephrolithiasis (OR = 2.71; = .03), hypercalcemia (OR = 5.30; < .001), and PHPT (OR = 12.59; = .008) as well as increased odds of incident osteopenia or osteoporosis (OR = 2.78; = .008), nephrolithiasis (OR = 4.95; < .001), hypercalcemia (OR = 7.58; < .001), and PHPT (OR = 148.01; < .001). An enlarged parathyroid gland indicated increased risk of PHPT as well as increased risk of preexisting and incident clinical conditions causally related to PHPT. Opportunistic CT-based assessment is a promising strategy for identifying patients at increased risk of undiagnosed PHPT; such assessment could potentially prevent some PHPT-related complications through earlier diagnosis and treatment.
原发性甲状旁腺功能亢进症（PHPT）的诊断不足。基于机会性成像的甲状旁腺评估是一种用于识别未诊断出的PHPT风险增加患者的建议策略。然而，这种方法是否可能识别出患有具有临床意义疾病的个体尚不清楚。本研究的目的是评估对比增强CT上甲状旁腺肿大与与PHPT因果相关的临床结局之间的关联。这项回顾性队列研究纳入了年龄在18岁及以上的患者，这些患者在2012年1月至2012年12月期间至少进行了一次胸部或颈部对比增强CT检查，至少进行了一次无日期限制的覆盖胸部或颈部区域的非对比CT检查，并且在2022年1月至2022年12月期间在医疗系统中至少有一次临床就诊。一名神经放射科医生对CT检查进行了评估，以确定2012年研究中甲状旁腺是否肿大。从电子健康记录（EHR）中提取患者的人口统计学数据、血清钙结果以及与PHPT因果相关的临床结局的诊断代码。如果在2012年对比增强CT检查之前记录，则钙结果和诊断代码被分类为既往存在的；如果在2012年对比增强CT检查之后记录，则被分类为新发的。该队列包括1198名患者（593名男性和605名女性；平均年龄51.6岁），其中43名（3.6%）在2012年对比增强CT检查中被评估为甲状旁腺肿大。在甲状旁腺肿大的患者中，16.3%被诊断为PHPT，而在无甲状旁腺肿大的患者中，这一比例为0.3%（P<0.001）。在对年龄、性别、种族和民族进行调整后，对比增强CT上甲状旁腺肿大与既往肾结石（OR = 2.71；P = 0.03）、高钙血症（OR = 5.30；P < 0.001）和PHPT（OR = 12.59；P = 0.008）的几率显著增加以及新发骨质减少或骨质疏松（OR = 2.78；P = 0.008）、肾结石（OR = 4.95；P < 0.001）、高钙血症（OR = 7.58；P < 0.001）和PHPT（OR = 148.01；P < 0.001）的几率增加相关。甲状旁腺肿大表明PHPT风险增加以及与PHPT因果相关的既往和新发临床状况的风险增加。基于机会性CT的评估是一种有前景的策略，用于识别未诊断出的PHPT风险增加的患者；这种评估有可能通过早期诊断和治疗预防一些与PHPT相关的并发症。
