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Four‐dimensional computed tomography for parathyroid localization: a new imaging modality
Author(s) -
Brown Sebastian J.,
Lee James C.,
Christie James,
Maher Richard,
Sidhu Stanley B.,
Sywak Mark S.,
Delbridge Leigh W.
Publication year - 2015
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12571
Subject(s) - medicine , primary hyperparathyroidism , radiology , retrospective cohort study , scintigraphy , histopathology , nuclear medicine , surgery , pathology
Four‐dimensional computed tomography (4 DCT ) is a new parathyroid localization technique not previously reported in A ustralia. It provides both functional and anatomical imaging in a single test, with superior sensitivity compared with sestamibi scintigraphy ( SeS ). This study examines the utility of 4 DCT in defined clinical situations. Methods This is a retrospective cohort study in a tertiary referral hospital setting. One hundred consecutive operative cases of primary hyperparathyroidism (99 patients) undergoing both preoperative 4 DCT and SeS . Localization studies were correlated with operative findings, histopathology and clinical outcomes. The utility of 4 DCT was analysed in three common clinical settings: primary cases with positive SeS (Group A, n = 68), primary cases with negative SeS (Group B, n = 21) and re‐operative cases (Group C , n = 11). Results The overall sensitivity of 4 DCT was 92% compared with 70% for SeS . The sensitivity of 4 DCT was superior to SeS in Groups B and C (76% versus 0% and 91% versus 46%, respectively). The overall cure rate was 98%, with 94% of cases completed as minimally invasive procedures. Up to 62% of Group B cases potentially avoided a bilateral neck exploration owing to a positive 4 DCT . Conclusions 4 DCT is an accurate technique providing both functional and anatomical localization of abnormal parathyroid glands. However, the advantage of speed and simplicity in image acquisition needs to be balanced against the small risk of increased radiation exposure in the younger patient group.