Yuan Tian1, Sharman Tan Tanny1, Paul Einsiedel2, Meir Lichtenstein3, Damien L Stella2,4, Pramit M Phal2, Julie A Miller5,6,7. 1. Endocrine Surgery Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. 2. Department of Radiology, Royal Melbourne Hospital, Parkville, VIC, Australia. 3. Department of Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia. 4. Department of Radiology, University of Melbourne, Parkville, VIC, Australia. 5. Endocrine Surgery Unit, Royal Melbourne Hospital, Parkville, VIC, Australia. Julie.Miller@mh.org.au. 6. Department of Surgery, University of Melbourne, Parkville, VIC, Australia. Julie.Miller@mh.org.au. 7. Epworth Freemasons Hospital, East Melbourne, VIC, Australia. Julie.Miller@mh.org.au.
Abstract
BACKGROUND: In recent years, four-dimensional computed tomography (4DCT) has emerged as a new localization study for primary hyperparathyroidism (pHPT). OBJECTIVE: We aimed to assess the added value of 4DCT in our institution in the first 4 years of use. METHODS: A retrospective cohort study was conducted from February 2004 to June 2015. Since 2011, patients over 50 years of age without concordant sestamibi-SPECT (SeS) and ultrasound (US) findings underwent 4DCT. Imaging results, surgical findings, histopathology, and postoperative biochemistry were collected. RESULTS: A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22). CONCLUSION: Parathyroid 4DCT can aid surgical planning in cases without concordant SeS/US findings; however, the introduction of 4DCT as a second-line test did not change our overall cure rate or rate of minimally invasive parathyroidectomy. The role of 4DCT as the primary localization study for pHPT merits further investigation.
BACKGROUND: In recent years, four-dimensional computed tomography (4DCT) has emerged as a new localization study for primary hyperparathyroidism (pHPT). OBJECTIVE: We aimed to assess the added value of 4DCT in our institution in the first 4 years of use. METHODS: A retrospective cohort study was conducted from February 2004 to June 2015. Since 2011, patients over 50 years of age without concordant sestamibi-SPECT (SeS) and ultrasound (US) findings underwent 4DCT. Imaging results, surgical findings, histopathology, and postoperative biochemistry were collected. RESULTS: A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22). CONCLUSION: Parathyroid 4DCT can aid surgical planning in cases without concordant SeS/US findings; however, the introduction of 4DCT as a second-line test did not change our overall cure rate or rate of minimally invasive parathyroidectomy. The role of 4DCT as the primary localization study for pHPT merits further investigation.
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