Altintop Sabri Engin, Cerit Mahi Nur, Cindil Emetullah, Sendur Halit Nahit, Barlas Tugba, Yalcin Mehmet Muhittin, Altinova Alev Eroglu, Akturk Mujde, Toruner Fusun Balos, Karakoc Mehmet Ayhan, Cerit Ethem Turgay
Gazi University Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkey.
Gazi University Faculty of Medicine, Department of Radiology, Ankara, Turkey.
Endocrine. 2025 Apr 22. doi: 10.1007/s12020-025-04239-2.
It can be challenging to localize the lesions in certain cases of primary hyperparathyroidism. Recently, it has been proposed that assessing the localization of parathyroid lesions with dynamic images enhances the diagnostic power of standard MRI (magnetic resonance imaging) due to the hypervascular structure of these lesions. In this study, we aimed to evaluate the success of four-dimensional dynamic perfusion MRI (4D MRI) in localizing parathyroid lesions.
Thirty patients who underwent 4-dimensional dynamic MRI diagnosed with primary hyperparathyroidism and indications for surgery, whose USG (ultrasonography) and/or Tc 99m sestamibi SPECT scan were negative or discordant, were included. The sensitivity and positive predictive values (PPV) were calculated for each imaging modality.
Of the 30 patients, 29 had parathyroid adenoma, and one had parathyroid hyperplasia in histopathologic examination. 4D MRI accurately identified the location of parathyroid lesions in 25 of 30 patients (sensitivity 83.3%, PPV 96.1%), whereas USG successfully identified the lesion location in 21 patients (sensitivity 70%, PPV 91.3%) and Tc 99m sestamibi SPECT scan in 17 patients (sensitivity 56.7%, PPV 94.4%). The sensitivity of the combination of three imaging modalities was found to be 96.7%.
4D MRI can be utilized as a complementary imaging modality to localize parathyroid lesions, offering the advantage of no ionizing radiation, especially when USG and/or Tc 99m sestamibi SPECT scans cannot reliably identify them.
在某些原发性甲状旁腺功能亢进病例中，定位病变可能具有挑战性。最近，有人提出，由于这些病变的血管丰富结构，利用动态图像评估甲状旁腺病变的定位可提高标准MRI（磁共振成像）的诊断能力。在本研究中，我们旨在评估四维动态灌注MRI（4D MRI）在定位甲状旁腺病变方面的成功率。
纳入30例接受四维动态MRI检查、诊断为原发性甲状旁腺功能亢进且有手术指征的患者，其超声检查（USG）和/或锝99m甲氧基异丁基异腈单光子发射计算机断层扫描（Tc 99m sestamibi SPECT）扫描结果为阴性或不一致。计算每种成像方式的敏感性和阳性预测值（PPV）。
30例患者中，29例组织病理学检查为甲状旁腺腺瘤，1例为甲状旁腺增生。4D MRI准确识别了30例患者中25例甲状旁腺病变的位置（敏感性83.3%，PPV 96.1%），而USG成功识别了21例患者的病变位置（敏感性70%，PPV 91.3%），Tc 99m sestamibi SPECT扫描识别了17例患者的病变位置（敏感性56.7%，PPV 94.4%）。三种成像方式联合使用的敏感性为96.7%。
4D MRI可作为一种辅助成像方式用于定位甲状旁腺病变，具有无电离辐射的优势，特别是在USG和/或Tc 99m sestamibi SPECT扫描无法可靠识别病变时。
