Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: How many phases do we really need?

被引:30
作者
Noureldine, Salem I. [1 ]
Aygun, Nafi [2 ]
Walden, Michael J. [2 ]
Hassoon, Ahmed [3 ]
Gujar, Sachin K. [2 ]
Tufano, Ralph P. [1 ]
机构
[1] Johns Hopkins Univ, Sch Med, Dept Otolaryngol Head & Neck Surg, Div Head & Neck Endocrine Surg, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Sch Med, Dept Radiol & Radiol Sci, Baltimore, MD USA
[3] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA
关键词
PREOPERATIVE LOCALIZATION; SESTAMIBI SCAN; ACCURACY; EXPLORATION; ULTRASOUND; GLANDS;
D O I
10.1016/j.surg.2014.08.002
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Multiphase computed tomography (CT) involves multiple cervical CT acquisitions to accurately identify hyperfunctional parathyroid glands, thus increasing radiation exposure to the patient. We hypothesized that only 2 cervical acquisitions, instead of the conventional 4, would provide equivalent localization information and halve the radiation exposure. Methods. We identified 53 consecutive patients with primary hyperparathyroidism who underwent multiphase CT before parathyroidectomy. All scans were reinterpreted first using 2 phases then using all 4 phases. The accuracies of interpretations were determined with surgical findings serving as the standard of reference. Results. Sixty-four hyperfunctional parathyroid glands were resected with a mean weight of 394.3 mg Two-phase CT lateralized the hyperfunctional glands in 38 patients with a sensitivity, positive predictive value (PPV), and accuracy of 100%, 71.7%, and 71.7%, respectively. Four-phase CT lateralized the hyperfunctional glands in 39 patients with a sensitivity, PPV, and accuracy of 95.1%, 76.5%, and 73.6%, respectively. For quadrant localization, the accuracy of 2-phase and 4-phase CT was 50.9% and 52.8%, respectively. Conclusion. Our results suggest that 2-phase and 4-phase CT provide an equivalent diagnostic accuracy in localizing hyperfunctional parathyroid glands. The reduced radiation exposure to the patient may make 2-phase acquisitions a more acceptable alternative for preoperative localization.
引用
收藏
页码:1300 / 1307
页数:8
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