Krol Jorian P, Veerbeek Tessa, Deden Laura N, Joosten Frank B M, Bernsen Marie Louise E, Slump Cornelis H, Oyen Wim J G
Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, University of Twente, Enschede, the Netherlands.
Eur J Radiol Open. 2025 Jun 24;15:100669. doi: 10.1016/j.ejro.2025.100669. eCollection 2025 Dec.
Primary hyperparathyroidism, characterized by excessive parathyroid hormone secretion, is typically caused by solitary parathyroid adenomas or multiglandular disease. Accurate preoperative localization is critical for successful surgical parathyroidectomy. While four-dimensional CT (4DCT) is commonly used for this purpose, spectral-CT techniques have recently been introduced, offering improved tissue differentiation. Rapid kV switching and dual-source spectral-CT have been studied, however, this is the first study that evaluates the effectiveness of dual-layer-CT in preoperatively locating parathyroid adenomas in a larger population.
From April 2020 to October 2023, patients with confirmed primary hyperparathyroidism underwent dual-layer spectral 4DCT before surgery. Spectral reconstructions (MonoE40keV, Iodine-Density, Z-effective, Iodine-no-Water, Virtual Non-Contrast) were analyzed alongside conventional CT reconstructions. Mean attenuation values were compared using one-way ANOVA. ROC curves with paired-sample analysis assessed the ability of different reconstructions to distinguish between thyroid and parathyroid tissue, and lymph nodes and parathyroid tissue.
Thirty-six patients with thirty-nine parathyroid adenomas were analyzed. Conventional CT reconstructions demonstrated significantly higher AUC values for differentiating thyroid from parathyroid tissue across all phases compared to spectral reconstructions (0.83-0.95 vs. 0.65-0.89, p-value 0.007-<0.001). No significant difference was found between conventional and spectral reconstructions in distinguishing lymph nodes from parathyroid tissue (0.64-0.96 vs. 0.58-0.96, p-value 0.070-0.957). Virtual non-contrast (VNC) reconstructions showed smaller attenuation differences and lower AUC values in arterial and delayed phases compared to true non-contrast (p = 0.031 and 0.034).
Dual-layer spectral-CT is comparable or inferior to conventional CT in tissue differentiation. VNC reconstructions are not recommended as a substitute for true non-contrast due to inconsistent results. In this cohort, dual-layer spectral 4DCT did not demonstrate clear clinical advantage; further validation is warranted.
原发性甲状旁腺功能亢进症的特征是甲状旁腺激素分泌过多，通常由孤立性甲状旁腺腺瘤或多腺体疾病引起。准确的术前定位对于成功进行甲状旁腺手术切除至关重要。虽然四维CT（4DCT）通常用于此目的，但光谱CT技术最近已被引入，可提供更好的组织区分能力。快速千伏切换和双源光谱CT已得到研究，然而，这是第一项在更大规模人群中评估双层CT术前定位甲状旁腺腺瘤有效性的研究。
从2020年4月至2023年10月，确诊为原发性甲状旁腺功能亢进症的患者在手术前接受双层光谱4DCT检查。光谱重建（单能40keV、碘密度、有效原子序数、无水碘、虚拟平扫）与传统CT重建一起进行分析。使用单因素方差分析比较平均衰减值。采用配对样本分析的ROC曲线评估不同重建方法区分甲状腺与甲状旁腺组织以及淋巴结与甲状旁腺组织的能力。
分析了36例患有39个甲状旁腺腺瘤的患者。与光谱重建相比，传统CT重建在所有阶段区分甲状腺与甲状旁腺组织的AUC值显著更高（0.83 - 0.95对0.65 - 0.89，p值0.007 - <0.001）。在区分淋巴结与甲状旁腺组织方面，传统重建与光谱重建之间未发现显著差异（0.64 - 0.96对0.58 - 0.96，p值0.070 - 0.957）。与真正的平扫相比，虚拟平扫（VNC）重建在动脉期和延迟期显示出较小的衰减差异和较低的AUC值（p = 0.031和0.034）。
双层光谱CT在组织区分方面与传统CT相当或更差。由于结果不一致，不建议将VNC重建作为真正平扫的替代方法。在该队列中，双层光谱4DCT未显示出明显的临床优势；需要进一步验证。
