K Nael1, J Hur2, A Bauer2, R Khan2, A Sepahdari3, R Inampudi2, M Guerrero4. 1. From the Departments of Medical Imaging (K.N., J.H., A.B., R.K., R.I.) Department of Radiology (K.N.), Neuroradiology Section, Icahn School of Medicine at Mount Sinai, New York, New York Kambiznael@gmail.com. 2. From the Departments of Medical Imaging (K.N., J.H., A.B., R.K., R.I.). 3. Department of Radiological Sciences (A.S.), University of California, Los Angeles, Los Angeles, California. 4. Surgery (M.G.), University of Arizona, Tucson, Arizona.
Abstract
BACKGROUND AND PURPOSE: The hypervascular nature of parathyroid adenomas can be explored by proper dynamic imaging to narrow the target lesions for surgical exploration. The purpose of this study was to establish MR perfusion characteristics of parathyroid adenomas to differentiate them from their mimics, such as subjacent thyroid tissue and cervical lymph nodes. MATERIALS AND METHODS: Preoperative high-spatial and -temporal resolution dynamic 4D contrast-enhanced MR imaging in 30 patients with surgically proved parathyroid adenomas was evaluated retrospectively. Using coregistered images, we placed ROIs over the parathyroid adenoma, thyroid gland, and a cervical lymph node (jugulodigastric) to obtain peak enhancement, time-to-peak, wash-in, and washout in each patient. Data were analyzed by logistic regression and analysis of variance. Receiver operating characteristic analysis was performed to determine the optimal parameters for determination of parathyroid adenomas versus thyroid tissue and cervical lymph nodes. RESULTS: Parathyroid adenomas showed significantly (P < .05) faster time-to-peak, higher wash-in, and higher washout compared with cervical lymph nodes and significantly (P < .05) higher peak enhancement, faster time-to-peak, higher wash-in, and higher washout compared with thyroid tissue. Logistic regression analysis indicated significant contribution from time-to-peak (P = .02), wash-in (P = .03), and washout (P = .008) for differentiation of parathyroid adenomas from thyroid and cervical lymph nodes. Using receiver operating characteristic analysis, we obtained the best diagnostic accuracy from a combination of time-to-peak/wash-in/washout in the differentiation of parathyroid adenomas versus lymph nodes (area under the curve, 0.96; sensitivity/specificity, 88%/90%) and in distinguishing parathyroid adenomas versus thyroid tissue (area under the curve, 0.96; sensitivity/specificity, 91%/95%). CONCLUSIONS: Dynamic 4D contrast-enhanced MR imaging can be used to exploit the hypervascular nature of parathyroid adenomas. Multiparametric MR perfusion can distinguish parathyroid adenomas from subjacent thyroid tissue or lymph nodes with diagnostic accuracies of 96%.
BACKGROUND AND PURPOSE: The hypervascular nature of parathyroid adenomas can be explored by proper dynamic imaging to narrow the target lesions for surgical exploration. The purpose of this study was to establish MR perfusion characteristics of parathyroid adenomas to differentiate them from their mimics, such as subjacent thyroid tissue and cervical lymph nodes. MATERIALS AND METHODS: Preoperative high-spatial and -temporal resolution dynamic 4D contrast-enhanced MR imaging in 30 patients with surgically proved parathyroid adenomas was evaluated retrospectively. Using coregistered images, we placed ROIs over the parathyroid adenoma, thyroid gland, and a cervical lymph node (jugulodigastric) to obtain peak enhancement, time-to-peak, wash-in, and washout in each patient. Data were analyzed by logistic regression and analysis of variance. Receiver operating characteristic analysis was performed to determine the optimal parameters for determination of parathyroid adenomas versus thyroid tissue and cervical lymph nodes. RESULTS:Parathyroid adenomas showed significantly (P < .05) faster time-to-peak, higher wash-in, and higher washout compared with cervical lymph nodes and significantly (P < .05) higher peak enhancement, faster time-to-peak, higher wash-in, and higher washout compared with thyroid tissue. Logistic regression analysis indicated significant contribution from time-to-peak (P = .02), wash-in (P = .03), and washout (P = .008) for differentiation of parathyroid adenomas from thyroid and cervical lymph nodes. Using receiver operating characteristic analysis, we obtained the best diagnostic accuracy from a combination of time-to-peak/wash-in/washout in the differentiation of parathyroid adenomas versus lymph nodes (area under the curve, 0.96; sensitivity/specificity, 88%/90%) and in distinguishing parathyroid adenomas versus thyroid tissue (area under the curve, 0.96; sensitivity/specificity, 91%/95%). CONCLUSIONS: Dynamic 4D contrast-enhanced MR imaging can be used to exploit the hypervascular nature of parathyroid adenomas. Multiparametric MR perfusion can distinguish parathyroid adenomas from subjacent thyroid tissue or lymph nodes with diagnostic accuracies of 96%.
Authors: Amit Mahajan; Lee F Starker; Monica Ghita; Robert Udelsman; James A Brink; Tobias Carling Journal: World J Surg Date: 2012-06 Impact factor: 3.352
Authors: Lee F Starker; Amit Mahajan; Peyman Björklund; Gordon Sze; Robert Udelsman; Tobias Carling Journal: Ann Surg Oncol Date: 2010-12-24 Impact factor: 5.344
Authors: Steven Haker; William M Wells; Simon K Warfield; Ion-Florin Talos; Jui G Bhagwat; Daniel Goldberg-Zimring; Asim Mian; Lucila Ohno-Machado; Kelly H Zou Journal: Med Image Comput Comput Assist Interv Date: 2005
Authors: Melinda M Mortenson; Douglas B Evans; Jeffrey E Lee; George J Hunter; Dawid Shellingerhout; Thinh Vu; Beth S Edeiken; Lei Feng; Nancy D Perrier Journal: J Am Coll Surg Date: 2008-03-24 Impact factor: 6.113
Authors: Allison M Grayev; Lindell R Gentry; Michael J Hartman; Herbert Chen; Scott B Perlman; Scott B Reeder Journal: Ann Surg Oncol Date: 2011-08-31 Impact factor: 5.344
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: N Acar; M Haciyanli; M Coskun; N K Erdogan; S C Celik; S G Haciyanli; E O Gur Journal: Ann R Coll Surg Engl Date: 2020-01-10 Impact factor: 1.891
Authors: Abdullah A Alharbi; Fahad M Alshehri; Abdulrahman A Albatly; Bert-Ram Sah; Christoph Schmid; Gerhard F Huber; Martin W Huellner Journal: Mol Imaging Biol Date: 2018-10 Impact factor: 3.488
Authors: G F Huber; M Hüllner; C Schmid; A Brunner; B Sah; D Vetter; P A Kaufmann; G K von Schulthess Journal: Eur Radiol Date: 2018-01-25 Impact factor: 5.315