Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: A retrospective review

Objective: This study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism. Methods: The CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas. Results: The parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p=0.695). These results are similar to those found in the literature for multiphase CT of 55-94%. Conclusions: Our study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: A single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.

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Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: A retrospective review

10.7287/peerj.preprints.3058v1 ◽

2017 ◽

Author(s):

Fanny Moron ◽

Alfred Delumpa ◽

Justin Chetta ◽

Danielle Guffey ◽

David Dunaway

Keyword(s):

Primary Hyperparathyroidism ◽

Single Phase ◽

Parathyroid Glands ◽

Ct Scans ◽

Arterial Phase ◽

Phase Method ◽

Dual Phase ◽

Parathyroid Adenomas ◽

Multiphase Ct ◽

Parathyroid Imaging

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Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: a retrospective review

PeerJ ◽

10.7717/peerj.3586 ◽

2017 ◽

Vol 5 ◽

pp. e3586 ◽

Cited By ~ 3

Author(s):

Fanny Morón ◽

Alfred Delumpa ◽

Justin Chetta ◽

Danielle Guffey ◽

David Dunaway

Keyword(s):

Primary Hyperparathyroidism ◽

Single Phase ◽

Parathyroid Glands ◽

Ct Scans ◽

Arterial Phase ◽

Phase Method ◽

Dual Phase ◽

Parathyroid Adenomas ◽

Multiphase Ct ◽

Parathyroid Imaging

Objective This study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism. Methods The CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas. Results The parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p = 0.695). These results are similar to those found in the literature for multiphase CT of 55–94%. Conclusions Our study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: a single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.

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Parathyroid Imaging by 18F-Fluorocholine PET/CT in Patients With Primary Hyperparathyroidism and Inconclusive Conventional Methods: Clinico-Pathological Correlations

Physiological Research ◽

10.33549/physiolres.934029 ◽

2018 ◽

pp. S551-S557 ◽

Cited By ~ 7

Author(s):

K. ZAJÍČKOVÁ ◽

D. ZOGALA ◽

J. KUBINYI

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Glands ◽

Emission Tomography ◽

Positron Emission ◽

Pet Ct ◽

Parathyroid Adenomas ◽

Parathyroid Lesions ◽

Mean Size ◽

Parathyroid Imaging ◽

Mibi Scintigraphy

18F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and 99Tc-sestaMIBI SPECT (MIBI) scintigraphy in patients with primary hyperparathyroidism (PHPT) to localize abnormal parathyroid glands before surgery. The results were retrospectively evaluated and compared to postoperative histopathological findings. 13 patients with PHPT were enrolled (mean age 64.3 years, preoperative calcium 2.74 mmol/l and parathyroid hormone 114.6 ng/l). FCH localized hyperfunctioning parathyroid glands in 12 patients of 13 (per patient sensitivity 92 % and positive predictive value (PPV) 100 %). Fourteen parathyroid lesions (11 adenomas, 3 hyperplastic glands) were resected with a mean size of 11.9 mm (per lesion sensitivity 93 % and PPV 81 %). Four adenomas and one hyperplastic gland were composed of only chief cells, whereas five lesions contained both chief and oxyphil cells. In three patients an exclusively oxyphil adenoma was found, surprisingly with negative MIBI scintigraphy in spite of a high mitochondria content in the oxyphil parathyroid cells. 12 of 13 patients had thyroid disease. In our limited study sample, FCH correctly identified parathyroid adenomas and/or hyperplastic glands in 92 % of patients with previously inconclusive conventional imaging. Unlike MIBI, FCH successfully localized small, hyperplastic and multiple hyperfunctioning parathyroid glands, irrespective of their histopathological composition.

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Concomitant primary hyperparathyroidism with papillary thyroid carcinoma: The role of dual-phase 99mTc-MIBI parathyroid imaging: case report

Endocrine Abstracts ◽

10.1530/endoabs.56.p269 ◽

2018 ◽

Author(s):

Adina Anghel ◽

Gabriela Vasiliu ◽

Maria Christina Ungureanu ◽

Cristina Preda ◽

Voichita Mogos ◽

...

Keyword(s):

Case Report ◽

Papillary Thyroid Carcinoma ◽

Primary Hyperparathyroidism ◽

Thyroid Carcinoma ◽

Dual Phase ◽

Papillary Thyroid ◽

99Mtc Mibi ◽

Parathyroid Imaging

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Value of Ultrasonography, CT and MR Imaging in the Diagnosis of Primary Hyperparathyroidism

Acta Radiologica ◽

10.1177/02841851960373p260 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 720-726 ◽

Cited By ~ 7

Author(s):

C. Tziakouri ◽

E. Eracleous ◽

S. Skannavis ◽

A. Pierides ◽

P. Symeonides ◽

...

Keyword(s):

Mr Imaging ◽

Primary Hyperparathyroidism ◽

Detection Rate ◽

Cost Effective ◽

Clinical Results ◽

Parathyroid Glands ◽

Preoperative Localization ◽

Confirmatory Test ◽

Parathyroid Adenomas ◽

Ectopic Parathyroid

Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgical outcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in 87% of these patients. Conclusion: US, CT and MR imaging followed by surgery performed by an experienced surgeon provided good clinical results in 39 patients with primary hyperparathyroidism. Preoperative localization was especially useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the root of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.

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Multi-Phase CT-Based Radiomics Nomogram for Discrimination Between Pancreatic Serous Cystic Neoplasm From Mucinous Cystic Neoplasm

Frontiers in Oncology ◽

10.3389/fonc.2021.699812 ◽

2021 ◽

Vol 11 ◽

Author(s):

Jiahao Gao ◽

Fang Han ◽

Xiaoshuang Wang ◽

Shaofeng Duan ◽

Jiawen Zhang

Keyword(s):

Single Phase ◽

Validation Cohort ◽

Curve Analysis ◽

Ct Scans ◽

Cystic Neoplasm ◽

Arterial Phase ◽

Imaging Features ◽

Cystic Neoplasms ◽

Training Cohort ◽

Multi Phase

PurposeThis study aimed to develop and verify a multi-phase (MP) computed tomography (CT)-based radiomics nomogram to differentiate pancreatic serous cystic neoplasms (SCNs) from mucinous cystic neoplasms (MCNs), and to compare the diagnostic efficacy of radiomics models for different phases of CT scans.Materials and MethodsA total of 170 patients who underwent surgical resection between January 2011 and December 2018, with pathologically confirmed pancreatic cystic neoplasms (SCN=115, MCN=55) were included in this single-center retrospective study. Radiomics features were extracted from plain scan (PS), arterial phase (AP), and venous phase (VP) CT scans. Algorithms were performed to identify the optimal features to build a radiomics signature (Radscore) for each phase. All features from these three phases were analyzed to develop the MP-Radscore. A combined model comprised the MP-Radscore and imaging features from which a nomogram was developed. The accuracy of the nomogram was evaluated using receiver operating characteristic (ROC) curves, calibration tests, and decision curve analysis.ResultsFor each scan phase, 1218 features were extracted, and the optimal ones were selected to construct the PS-Radscore (11 features), AP-Radscore (11 features), and VP-Radscore (12 features). The MP-Radscore (14 features) achieved better performance based on ROC curve analysis than any single phase did [area under the curve (AUC), training cohort: MP-Radscore 0.89, PS-Radscore 0.78, AP-Radscore 0.83, VP-Radscore 0.85; validation cohort: MP-Radscore 0.88, PS-Radscore 0.77, AP-Radscore 0.83, VP-Radscore 0.84]. The combination nomogram performance was excellent, surpassing those of all other nomograms in both the training cohort (AUC, 0.91) and validation cohort (AUC, 0.90). The nomogram also performed well in the calibration and decision curve analyses.ConclusionsRadiomics for arterial and venous single-phase models outperformed the plain scan model. The combination nomogram that incorporated the MP-Radscore, tumor location, and cystic number had the best discriminatory performance and showed excellent accuracy for differentiating SCN from MCN.

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4DCT Scanning Technique for Primary Hyperparathyroidism: A Scoping Review

Radiology Research and Practice ◽

10.1155/2021/6614406 ◽

2021 ◽

Vol 2021 ◽

pp. 1-12

Author(s):

Steven Raeymaeckers ◽

Maurizio Tosi ◽

Johan De Mey

Keyword(s):

Primary Hyperparathyroidism ◽

Sensitivity And Specificity ◽

Arterial Phase ◽

Literature Study ◽

Tube Voltage ◽

Bolus Tracking ◽

Tube Current ◽

Parathyroid Adenomas ◽

Wide Range ◽

Almost All

Objective. 4DCT for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. Protocols are often institution-specific; this review aims to summarize the different protocols and explore the reported sensitivity and specificity of different 4DCT protocols as well as the associated dose. Materials and Methods. A literature study was independently conducted by two radiologists from April 2020 until May 2020 using the Medical Literature Analysis and Retrieval System Online (MEDLINE) database. Articles were screened and assessed for eligibility. From eligible studies, data were extracted to summarize different parameters of the scanning protocol and observed diagnostic attributes. Results. A total of 51 articles were included and 56 scanning protocols were identified. Most protocols use three (n = 25) or four different phases (n = 23). Almost all authors include noncontrast enhanced imaging and an arterial phase. Arterial images are usually obtained 25–30 s after administration of contrast, and less agreement exists concerning the timing of the venous phase(s). A mean contrast bolus of 100 mL is administered at 3-4 mL/s. Bolus tracking is not often used (n = 3). A wide range of effective doses are reported, up to 28 mSv. A mean sensitivity of 81.5% and a mean specificity of 86% are reported. Conclusion. Many different 4DCT scanning protocols for the detection of parathyroid adenomas exist in the literature. The number of phases does not appear to affect sensitivity or specificity. A triphasic approach, however, seems preferable, as three patterns of enhancement of parathyroid adenomas are described. Bolus tracking could help to reduce the variability of enhancement. Sensitivity and specificity also do not appear to be affected by other scan parameters like tube voltage or tube current. To keep the effective dose within limits, scanning at a lower fixed tube current seems preferable. Lowering tube voltage from 120 kV to 100 kV may yield similar image contrast but would also help lower the dose.

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Exclusive underexpression of vitamin D receptor exon 1f transcripts in tumors of primary hyperparathyroidism

Acta Endocrinologica ◽

10.1530/eje.0.1470671 ◽

2002 ◽

pp. 671-675 ◽

Cited By ~ 7

Author(s):

P Correa ◽

G Akerstrom ◽

G Westin

Keyword(s):

Vitamin D ◽

Primary Hyperparathyroidism ◽

Vitamin D Receptor ◽

Direct Action ◽

Parathyroid Glands ◽

Mrna Levels ◽

Vdr Gene ◽

Dihydroxyvitamin D ◽

Parathyroid Adenomas ◽

Distal Promoter

OBJECTIVE: Primary hyperparathyroidism (pHPT) is characterized by excessive production of parathyroid hormone (PTH) due to parathyroid adenomas while uremic secondary HPT (sHPT) is caused by parathyroid hyperplasia in response to renal failure. Active vitamin D, 1,25-dihydroxyvitamin D(3) (1,25-(OH)(2)D(3)), with the vitamin D receptor (VDR) is involved in regulation of the calcium homeostasis together with PTH. In a feedback loop, 1,25-(OH)(2)D(3) has a direct action on the parathyroid gland to regulate PTH transcription, PTH secretion and cell proliferation. We have previously demonstrated reduced VDR mRNA expression in parathyroid adenomas and hyperplasia of sHPT using a probe detecting all 14 variant VDR transcripts expressed in parathyroid cells. Here we have assessed which of the 5'-terminal exon 1a, 1d and 1f variant VDR transcripts are reduced in pathological parathyroid glands. METHODS: The relative VDR/glyceraldehyde-3-phosphate dehydrogenase mRNA levels for each VDR exon were determined by real-time quantitative RT-PCR in five normal parathyroid glands, seventeen parathyroid adenomas and ten hyperplastic glands of sHPT. RESULTS: The results demonstrated exclusive underexpression of VDR exon 1f transcripts in parathyroid adenoma, while all measured VDR transcripts were reduced in secondary hyperplasia. CONCLUSIONS: We suggest that exclusive underexpression of VDR exon 1f transcripts in adenomas of pHPT, which derive from a distal promoter active in tIssues involved in calcium regulation by 1,25-(OH)(2)D(3), may either reflect a defective cell type-specific transcription factor or other physiologically important pathway(s) for tIssue-specific VDR gene expression.

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Accuracy of Dual Phase Single-Photon Emission Computed Tomography/Computed Tomography in Primary Hyperparathyroidism: Correlation with Serum Parathyroid Hormone Levels

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2015.06.002 ◽

2016 ◽

Vol 67 (2) ◽

pp. 115-121 ◽

Cited By ~ 4

Author(s):

Wade Koberstein ◽

Christopher Fung ◽

Kristy Romaniuk ◽

Jonathan T. Abele

Keyword(s):

Computed Tomography ◽

Primary Hyperparathyroidism ◽

Predictive Value ◽

Single Photon ◽

Photon Emission ◽

Emission Computed Tomography ◽

Dual Phase ◽

Parathyroid Adenomas ◽

Ectopic Parathyroid ◽

Serum Pth

Purpose The objectives of this study were: 1) to determine the accuracy of dual-phase 99mTc -methoxyisobutylisonitrile (MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of parathyroid adenomas in the setting of primary hyperparathyroidism; 2) to determine the accuracy of localization for ectopic glands; and 3) to assess the relationship between accuracy and serum parathyroid hormone (PTH) levels. Methods Eighty-eight patients who underwent 99mTc-MIBI SPECT/CT imaging for primary hyperparathyroidism at our institution over a 27-month period were retrospectively assessed. The preoperative SPECT/CT results were compared to intraoperative findings (within 1 year of imaging). The relationship between serum PTH level (within 3 months) and SPECT/CT accuracy was then evaluated. Results Accuracy indices for the retrothyroid subgroup were sensitivity 86.7%, specificity 96.4%, positive predictive value 98.1%, negative predictive value 77.1%, and accuracy 89.8%. Accuracy indices for ectopic parathyroid adenomas were sensitivity 81.5%, specificity 100%, positive predictive value 100%, negative predictive value 92.4%, and accuracy 94.3%. For the overall group, SPECT/CT demonstrated a sensitivity of 85.1% and a PPV of 98.7%. SPECT/CT correctly identified the abnormal parathyroid gland in 60% of patients with a normal serum PTH (<6.9 pmol/L), 73% between 6.9-9.9 pmol/L, 86% between 10.0-14.9 pmol/L, 100% between 15.0-19.9 pmol/L, 88% between 20.0-24.5 pmol/L, and 100% of patients with a PTH greater than 25.0 pmol/L. Conclusions Dual-phase 99mTc- MIBI with SPECT/CT is an accurate and reliable means to correctly localize both retrothyroid and ectopic parathyroid adenomas for the purpose of surgical planning. The accuracy of SPECT/CT increases with increasing serum PTH levels.

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