Comparison of 4D CT, Ultrasonography, and 99mTc Sestamibi SPECT/CT in Localizing Single-Gland Primary Hyperparathyroidism

Objective The present study was designed to evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT). Study Design Case series with expertized image review. Setting Tertiary care hospital. Subjects and Methods A total of 38 patients were recruited for study, all of whom had undergone focused parathyroidectomy for single-lesion primary HPT between June 2011 and September 2013. In each patient, 3 imaging procedures were performed: cervical ultrasonography (US), Tc-99m-sestamibi SPECT/CT (SeS), and 4D CT. Collective imaging data were blindly reviewed and compared. Results 4D CT outperformed US and SeS in terms of sensitivity (P = .27), specificity (P = .01), positive predictive value (PPV) (P < .01), negative predictive value (NPV) (P = .19), and accuracy (P < .01). In 7.9% (3/38) of patients, 4D CT provided specific anatomic information that was unaffordable by US and SeS. Localization by 4D CT correlated with tissue parathyroid hormone level (P = .02), maximum diameter (P = .01), and volume (P < .01) of abnormal parathyroid glands. Conclusion 4D CT proved helpful in localizing target parathyroid glands of primary HPT that were missed by traditional imaging.