BACKGROUND: The aim of this study was to analyze the utility of preoperative thin cut (2.5 mm) computed tomography (CT) in patients with primary hyperparathyroidism (PHPT) and negative sestamibi scans. METHODS: A retrospective review of patients with PHPT was conducted from the prospective parathyroid registries of 2 tertiary referral centers. Of 482 patients, 63 with negative sestamibi scanning underwent thin cut CT of the neck and were included in the final analysis. RESULTS: CT was 85% sensitive and 94% specific for correctly lateralizing the side(s) of diseased glands and 66% sensitive and 89% specific for predicting exactly the location of diseased glands. Sixty-six percent of patients underwent focused explorations, and 87% of patients underwent parathyroidectomy under local anesthesia. Pathology revealed a single adenoma in 83%, multigland disease in 14%, carcinoma in 1%, and no pathology in 2%. Average operative time was 73 minutes overall, but only 55 minutes in patients with precise CT localization (P = .02). CONCLUSION: Thin cut CT is a helpful adjunct to preoperative workup in PHPT patients who have negative sestamibi localization and permits a focused neck exploration in a high percentage of those patients.
BACKGROUND: The aim of this study was to analyze the utility of preoperative thin cut (2.5 mm) computed tomography (CT) in patients with primary hyperparathyroidism (PHPT) and negative sestamibi scans. METHODS: A retrospective review of patients with PHPT was conducted from the prospective parathyroid registries of 2 tertiary referral centers. Of 482 patients, 63 with negative sestamibi scanning underwent thin cut CT of the neck and were included in the final analysis. RESULTS: CT was 85% sensitive and 94% specific for correctly lateralizing the side(s) of diseased glands and 66% sensitive and 89% specific for predicting exactly the location of diseased glands. Sixty-six percent of patients underwent focused explorations, and 87% of patients underwent parathyroidectomy under local anesthesia. Pathology revealed a single adenoma in 83%, multigland disease in 14%, carcinoma in 1%, and no pathology in 2%. Average operative time was 73 minutes overall, but only 55 minutes in patients with precise CT localization (P = .02). CONCLUSION: Thin cut CT is a helpful adjunct to preoperative workup in PHPT patients who have negative sestamibi localization and permits a focused neck exploration in a high percentage of those patients.
Authors: J L Becker; V Patel; K J Johnson; M Guerrero; R R Klein; G F Ranvier; R P Owen; P Pawha; K Nael Journal: AJNR Am J Neuroradiol Date: 2020-03-12 Impact factor: 3.825
Authors: P Raghavan; C R Durst; D A Ornan; S Mukherjee; M Wintermark; J T Patrie; W Xin; A L Shada; J B Hanks; P W Smith Journal: AJNR Am J Neuroradiol Date: 2014-06-05 Impact factor: 3.825