Additional value of 4D-CT in patients with primary hyperparathyroidism and negative conventional imaging; a reason to change primary imaging modality in patients over 60?

With increasing use of minimally invasive parathyroidectomy (PTx) over traditional bilateral neck exploration in patients with primary hyperparathyroidism (PHPT), accurate preoperative localization has become more important to enable a successful surgical outcome. Traditional imaging techniques such as ultrasound (US) and sestamibi scintigraphy (MIBI) and newer techniques such as parathyroid four-dimension computed tomography (4D-CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) are available for the clinician to detect the diseased gland(s) in the preoperative workup. Invasive parathyroid venous sampling may be useful in certain circumstances such as persistent or recurrent PHPT. We review the diagnostic performance of these imaging modalities in preoperative localization and discuss the advantages and weaknesses of these techniques. US and MIBI are established techniques commonly utilized as first-line modalities. 4D-CT has excellent diagnostic performance and is increasingly performed in first-line setting and as an adjunct to US and MIBI. PET and MRI are emerging adjunct modalities when localization has been equivocal or failed. Since no evidence-based guidelines are yet available for the optimal imaging strategy, clinicians should be familiar with the range and advancement of these techniques. Choice of imaging modality should be individualized to the patient with consideration for efficacy, expertise, and availability of such techniques in clinical practice.

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Additional Value of PET Radiomic Features for the Initial Staging of Prostate Cancer: A Systematic Review from the Literature

Cancers ◽

10.3390/cancers13236026 ◽

2021 ◽

Vol 13 (23) ◽

pp. 6026

Author(s):

Priscilla Guglielmo ◽

Francesca Marturano ◽

Andrea Bettinelli ◽

Michele Gregianin ◽

Marta Paiusco ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Imaging Modality ◽

Small Sample ◽

High Order ◽

Lesion Detection ◽

Qualitative Assessment ◽

Number Of Patients ◽

Additional Value ◽

Initial Staging

We performed a systematic review of the literature to provide an overview of the application of PET radiomics for the prediction of the initial staging of prostate cancer (PCa), and to discuss the additional value of radiomic features over clinical data. The most relevant databases and web sources were interrogated by using the query “prostate AND radiomic* AND PET”. English-language original articles published before July 2021 were considered. A total of 28 studies were screened for eligibility and 6 of them met the inclusion criteria and were, therefore, included for further analysis. All studies were based on human patients. The average number of patients included in the studies was 72 (range 52–101), and the average number of high-order features calculated per study was 167 (range 50–480). The radiotracers used were [68Ga]Ga-PSMA-11 (in four out of six studies), [18F]DCFPyL (one out of six studies), and [11C]Choline (one out of six studies). Considering the imaging modality, three out of six studies used a PET/CT scanner and the other half a PET/MRI tomograph. Heterogeneous results were reported regarding radiomic methods (e.g., segmentation modality) and considered features. The studies reported several predictive markers including first-, second-, and high-order features, such as “kurtosis”, “grey-level uniformity”, and “HLL wavelet mean”, respectively, as well as PET-based metabolic parameters. The strengths and weaknesses of PET radiomics in this setting of disease will be largely discussed and a critical analysis of the available data will be reported. In our review, radiomic analysis proved to add useful information for lesion detection and the prediction of tumor grading of prostatic lesions, even when they were missed at visual qualitative assessment due to their small size; furthermore, PET radiomics could play a synergistic role with the mpMRI radiomic features in lesion evaluation. The most common limitations of the studies were the small sample size, retrospective design, lack of validation on external datasets, and unavailability of univocal cut-off values for the selected radiomic features.

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Pathologic confirmation of valve thrombosis detected by four-dimensional computed tomography following valve-in-valve transcatheter aortic valve replacement

Global Cardiology Science and Practice ◽

10.21542/gcsp.2017.15 ◽

2017 ◽

Vol 2017 (2) ◽

Author(s):

Ambarish Gopal ◽

Nathalia Ribeiro ◽

John J Squiers ◽

Elizabeth M Holper ◽

Michael Black ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Thrombus Formation ◽

Imaging Modality ◽

4D Ct ◽

Transcatheter Aortic Valve ◽

Valve Thrombosis

A major concern regarding transcatheter aortic valve replacement (TAVR) is leaflet thrombosis. Four-dimensional computed tomography (4D-CT) is the preferred imaging modality to evaluate patients with suspected valve thrombosis. To date, the abnormal findings visualized by 4D-CT suggestive of leaflet thrombosis have lacked pathologic confirmation from a surgically explanted valve in a surviving patient. Herein, we provide pathologic confirmation of thrombus formation following surgical explantation of a thrombosed TAVR prosthesis that was initially identified by 4D-CT.

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Predictors of Multigland Disease in Primary Hyperparathyroidism: A Scoring System with 4D-CT Imaging and Biochemical Markers

American Journal of Neuroradiology ◽

10.3174/ajnr.a4213 ◽

2015 ◽

Vol 36 (5) ◽

pp. 987-992 ◽

Cited By ~ 20

Author(s):

A.R. Sepahdari ◽

M. Bahl ◽

A. Harari ◽

H.J. Kim ◽

M.W. Yeh ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Scoring System ◽

Biochemical Markers ◽

Ct Imaging ◽

4D Ct

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The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism

HORMONES ◽

10.1007/s42000-020-00205-x ◽

2020 ◽

Author(s):

Mechteld C. de Jong ◽

K. Jamal ◽

S. Morley ◽

T. Beale ◽

T. Chung ◽

...

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Imaging Modality ◽

First Line ◽

Line Imaging

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The additional value of intraoperative parathyroid hormone assessment is marginal in patients with nonfamilial primary hyperparathyroidism: a prospective cohort study

The American Journal of Surgery ◽

10.1016/j.amjsurg.2011.07.017 ◽

2012 ◽

Vol 204 (1) ◽

pp. 1-6 ◽

Cited By ~ 10

Author(s):

Bas A. Twigt ◽

Thijs van Dalen ◽

Anne M. Vollebregt ◽

Wouter Kortlandt ◽

Menno R. Vriens ◽

...

Keyword(s):

Cohort Study ◽

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Intraoperative Parathyroid Hormone ◽

Additional Value

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Additional value of linked color imaging in colonoscopy: a retrospective study

Endoscopy International Open ◽

10.1055/a-0982-2904 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1448-E1454

Author(s):

Taku Sakamoto ◽

Yutaka Tomizawa ◽

Hourin Cho ◽

Hiroyuki Takamaru ◽

Masau Sekiguchi ◽

...

Keyword(s):

Imaging Modality ◽

Colorectal Polyp ◽

Proximal Colon ◽

Polyp Detection ◽

Color Imaging ◽

Single Center Study ◽

Linked Color Imaging ◽

Additional Value ◽

Withdrawal Phase ◽

White Light Imaging

Abstract Background and study aims Linked color imaging (LCI), a newly developed optical modality, enhances mucosal surface contrast. We aimed to evaluate the efficacy and feasibility of insertion-phase LCI in terms of additional benefit of colorectal polyp detection over that obtained with white light imaging (WLI). Patients and methods We consecutively enrolled eligible patients from November 2017 to June 2018. During colonoscopy, LCI or WLI was alternatively applied on scope insertion and LCI was applied on scope withdrawal. Patients were divided into two groups according to the protocolized difference of imaging modality used in the scope insertion phase (LCI and WLI groups). Group differences in clinical outcomes were evaluated. Results A total of 138 patients were enrolled in this study, with equal numbers of patients assigned to the LCI and WLI groups. Most of the lesions located in the proximal colon were detected during the withdrawal phase, without a difference in proportions between the two groups. However, in the LCI group, eight of 49 lesions (16 %) located in the sigmoid and rectosigmoid colon were only detected during the insertion phase, and no such lesions (0 %) were detected during the insertion phase in the WLI group (P = 0.045). Conclusions This study showed the efficacy and feasibility of LCI in improving colorectal polyp detection in the sigmoid colon, especially during insertion. Further studies are warranted to validate the results of our single-center study.

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