Application of 4D-CT in Poorly Located Parathyroid Adenomas: Surgical Correlation

Introduction: Presurgical localization of parathyroid adenomas is important, improving surgical outcome and reducing its morbility. In the last years, cervico-thoracic four-dimensional computed tomography (4D-CT) has emerged as a complementary imaging technique to the traditional methods (ultrasound and scintigraphy) for presurgical localization of parathyroid adenomas of unknown location. We reviewed our initial experience in the use of 4D-CT in adults with primary hyperparathyroidism and negative or inconclusive traditional imaging modalities. Methods: Inclusion criteria were consecutive adults with primary hyperparathyroidism with negative or inconclusive traditional imaging modalities, who underwent 4D-CT and later curative surgery, between May 2015 and December 2017. We compared the report and images from 4D-CT to the histopathologic report after surgery. Results: Of the eleven patients who underwent cervical surgery, in 91% the histology was parathyroid adenoma (n=10) and in 9% parathyroid hyperplasia (n=1), with lowering of intraoperative parathyroid hormone in 77% of patients (n=7) and normalization of parathyroid hormone after surgery in 91% (n=10). 4D-CT identified all the cases of hyperfunctioning parathyroid tissue (n=11). Ultrasound and scintigraphy identified, respectively, 36% (n=4) and 18% (n=2) of the lesions. Conclusion: 4D-CT is a promising modality for localization of parathyroid adenomas of unknown location, as showed by our initial results, and should be considered in cases where ultrasound or scintigraphy were negative or inconclusive.