Hyperparathyroidism CT: Difference between revisions
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==Overview== | ==Overview== | ||
Good quality preoperative evaluation favors post operative results. 4- | Good quality preoperative evaluation favors post operative results. 4-dimentional CT scan is an investigation for preoperative localizing of hyper-functioning [[parathyroid gland]]. 4D-CT is significantly more sensitive than sestamibi imaging and ultrasound for precise (quadrant) localization of hyper-functioning parathyroid glands. 4D-CT provides extremely detailed images of neck in multiple planes and enables the visualization of difference in hyper-functioning [[parathyroid gland]] compared with normal parathyroid glands and other structures in the neck on the basis on [[perfusion]] characteristics ( rapid uptake and washout). 4D-CT is particularly useful in cases of re-operation. The major disadvantage of 4D-CT is significant [[radiation exposure]] associated with scanning the patient multiple times. | ||
==CT scan== | ==CT scan== | ||
*4-Dimentional CT scan is an investigation for preoperative localizing of | *4-Dimentional CT scan is an investigation for preoperative localizing of hyper-functioning [[parathyroid gland]].<ref name="pmid22798226">{{cite journal| author=Hunter GJ, Schellingerhout D, Vu TH, Perrier ND, Hamberg LM| title=Accuracy of four-dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. | journal=Radiology | year= 2012 | volume= 264 | issue= 3 | pages= 789-95 | pmid=22798226 | doi=10.1148/radiol.12110852 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22798226 }} </ref> | ||
*4D-CT may be used for preoperative localization of hyper-functioning parathyroid glands in hyperparathyroidism. 4D-CT is significantly more sensitive than sestamibi imaging and ultrasound for precise (quadrant) localization of hyper-functioning parathyroid glands.<ref name="pmid17188140">{{cite journal| author=Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD et al.| title=Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. | journal=Surgery | year= 2006 | volume= 140 | issue= 6 | pages= 932-40; discussion 940-1 | pmid=17188140 | doi=10.1016/j.surg.2006.07.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17188140 }} </ref> | *4D-CT may be used for preoperative localization of hyper-functioning [[Parathyroid gland|parathyroid glands]] in [[hyperparathyroidism]]. 4D-CT is significantly more sensitive than [[Sestamibi scan|Tc-99m sestamibi imaging]] and [[ultrasound]] for precise (quadrant) localization of hyper-functioning [[Parathyroid gland|parathyroid glands]].<ref name="pmid17188140">{{cite journal| author=Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD et al.| title=Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. | journal=Surgery | year= 2006 | volume= 140 | issue= 6 | pages= 932-40; discussion 940-1 | pmid=17188140 | doi=10.1016/j.surg.2006.07.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17188140 }} </ref> | ||
*The name 4D-CT refers to 3-dimensional CT scanning plus additional dimension of changes observed with respect to time as perfusion of contrast occurs. The principle is similar to CT angiography. | *The name 4D-CT refers to 3-dimensional CT scanning plus additional dimension of changes observed with respect to time as [[perfusion]] of contrast occurs. The principle is similar to [[CT angiography]]. | ||
*4D-CT provides extremely detailed images of neck in multiple planes and enables the visualization of difference in hyper-functioning parathyroid gland compared with normal parathyroid glands and other structures in the neck on the basis on perfusion characteristics ( rapid uptake and washout). | *4D-CT provides extremely detailed images of neck in multiple planes and enables the visualization of difference in hyper-functioning [[parathyroid gland]] compared with normal [[Parathyroid gland|parathyroid glands]] and other structures in the neck on the basis on [[perfusion]] characteristics ( rapid uptake and washout). | ||
*4D-CT has a | *4D-CT has a [[Sensitivity (tests)|sensitivity]] of 88% in preoperative lateralizing hyper-functioning [[Parathyroid gland|parathyroid glands]] to one side of neck.<ref name="pmid21367374">{{cite journal| author=Eichhorn-Wharry LI, Carlin AM, Talpos GB| title=Mild hypercalcemia: an indication to select 4-dimensional computed tomography scan for preoperative localization of parathyroid adenomas. | journal=Am J Surg | year= 2011 | volume= 201 | issue= 3 | pages= 334-8; discussion 338 | pmid=21367374 | doi=10.1016/j.amjsurg.2010.08.033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21367374 }} </ref> | ||
*4D-CT has a | *4D-CT has a [[Sensitivity (tests)|sensitivity]] of 79-88% in preoperative localizing the hyper-functioning [[parathyroid gland]] to the correct quadrant of the neck (right inferior, right superior, left inferior, or left superior).<ref name="pmid26359149">{{cite journal| author=Griffith B, Chaudhary H, Mahmood G, Carlin AM, Peterson E, Singer M et al.| title=Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism. | journal=AJNR Am J Neuroradiol | year= 2015 | volume= 36 | issue= 12 | pages= 2373-9 | pmid=26359149 | doi=10.3174/ajnr.A4473 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26359149 }} </ref> | ||
*4D-CT has a specificity of 75-100% in preoperative localizing the hyper-functioning parathyroid | *4D-CT has a [[Specificity (tests)|specificity]] of 75-100% in preoperative localizing the hyper-functioning [[Parathyroid gland|parathyroid glands]].<ref name="pmid21178047">{{cite journal| author=Beland MD, Mayo-Smith WW, Grand DJ, Machan JT, Monchik JM| title=Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism. | journal=AJR Am J Roentgenol | year= 2011 | volume= 196 | issue= 1 | pages= 61-5 | pmid=21178047 | doi=10.2214/AJR.10.4459 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21178047 }} </ref> | ||
*4D-CT enables an improved planning | *4D-CT enables an improved preoperative planning, particularly in case of re-operation. | ||
*A modified technique of 4D-CT/ | *A modified technique of 4D-CT/[[ultrasound]] (Mod 4D-CT/US) has a [[Sensitivity (tests)|sensitivity]] of 94% and [[Specificity (tests)|specificity]] of 96% for lateralizing the hyperfunctioning [[parathyroid glands]] to one side of the neck. Mod 4D-CT/US has a [[Sensitivity (tests)|sensitivity]] of 82% and [[Specificity (tests)|specificity]] of 93% for localizing the hyper-functioning [[Parathyroid gland|parathyroid glands]] to the correct quadrant of the neck (right inferior, right superior, left inferior, or left superior). Mod 4D-CT/US has a [[positive predictive value]] of 92% for single-gland disease and 75% for multi-gland disease. Mod 4D-CT/US has a [[negative predictive value]] of 73% for single-gland disease and 92% multi-gland disease.<ref name="pmid21557243">{{cite journal| author=Kutler DI, Moquete R, Kazam E, Kuhel WI| title=Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism. | journal=Laryngoscope | year= 2011 | volume= 121 | issue= 6 | pages= 1219-24 | pmid=21557243 | doi=10.1002/lary.21783 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21557243 }} </ref> | ||
*The major disadvantage of 4D-CT is significant radiation exposure associated with scanning the patient multiple times. | *The major disadvantage of 4D-CT is significant [[radiation exposure]] associated with scanning the patient multiple times. | ||
==References== | ==References== | ||
Revision as of 13:25, 5 September 2017
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American Roentgen Ray Society Images of Hyperparathyroidism CT |
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Risk calculators and risk factors for Hyperparathyroidism CT |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anmol Pitliya, M.B.B.S. M.D.[2]
Overview
Good quality preoperative evaluation favors post operative results. 4-dimentional CT scan is an investigation for preoperative localizing of hyper-functioning parathyroid gland. 4D-CT is significantly more sensitive than sestamibi imaging and ultrasound for precise (quadrant) localization of hyper-functioning parathyroid glands. 4D-CT provides extremely detailed images of neck in multiple planes and enables the visualization of difference in hyper-functioning parathyroid gland compared with normal parathyroid glands and other structures in the neck on the basis on perfusion characteristics ( rapid uptake and washout). 4D-CT is particularly useful in cases of re-operation. The major disadvantage of 4D-CT is significant radiation exposure associated with scanning the patient multiple times.
CT scan
- 4-Dimentional CT scan is an investigation for preoperative localizing of hyper-functioning parathyroid gland.[1]
- 4D-CT may be used for preoperative localization of hyper-functioning parathyroid glands in hyperparathyroidism. 4D-CT is significantly more sensitive than Tc-99m sestamibi imaging and ultrasound for precise (quadrant) localization of hyper-functioning parathyroid glands.[2]
- The name 4D-CT refers to 3-dimensional CT scanning plus additional dimension of changes observed with respect to time as perfusion of contrast occurs. The principle is similar to CT angiography.
- 4D-CT provides extremely detailed images of neck in multiple planes and enables the visualization of difference in hyper-functioning parathyroid gland compared with normal parathyroid glands and other structures in the neck on the basis on perfusion characteristics ( rapid uptake and washout).
- 4D-CT has a sensitivity of 88% in preoperative lateralizing hyper-functioning parathyroid glands to one side of neck.[3]
- 4D-CT has a sensitivity of 79-88% in preoperative localizing the hyper-functioning parathyroid gland to the correct quadrant of the neck (right inferior, right superior, left inferior, or left superior).[4]
- 4D-CT has a specificity of 75-100% in preoperative localizing the hyper-functioning parathyroid glands.[5]
- 4D-CT enables an improved preoperative planning, particularly in case of re-operation.
- A modified technique of 4D-CT/ultrasound (Mod 4D-CT/US) has a sensitivity of 94% and specificity of 96% for lateralizing the hyperfunctioning parathyroid glands to one side of the neck. Mod 4D-CT/US has a sensitivity of 82% and specificity of 93% for localizing the hyper-functioning parathyroid glands to the correct quadrant of the neck (right inferior, right superior, left inferior, or left superior). Mod 4D-CT/US has a positive predictive value of 92% for single-gland disease and 75% for multi-gland disease. Mod 4D-CT/US has a negative predictive value of 73% for single-gland disease and 92% multi-gland disease.[6]
- The major disadvantage of 4D-CT is significant radiation exposure associated with scanning the patient multiple times.
References
- ↑ Hunter GJ, Schellingerhout D, Vu TH, Perrier ND, Hamberg LM (2012). "Accuracy of four-dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism". Radiology. 264 (3): 789–95. doi:10.1148/radiol.12110852. PMID 22798226.
- ↑ Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD; et al. (2006). "Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography". Surgery. 140 (6): 932–40, discussion 940-1. doi:10.1016/j.surg.2006.07.028. PMID 17188140.
- ↑ Eichhorn-Wharry LI, Carlin AM, Talpos GB (2011). "Mild hypercalcemia: an indication to select 4-dimensional computed tomography scan for preoperative localization of parathyroid adenomas". Am J Surg. 201 (3): 334–8, discussion 338. doi:10.1016/j.amjsurg.2010.08.033. PMID 21367374.
- ↑ Griffith B, Chaudhary H, Mahmood G, Carlin AM, Peterson E, Singer M; et al. (2015). "Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism". AJNR Am J Neuroradiol. 36 (12): 2373–9. doi:10.3174/ajnr.A4473. PMID 26359149.
- ↑ Beland MD, Mayo-Smith WW, Grand DJ, Machan JT, Monchik JM (2011). "Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism". AJR Am J Roentgenol. 196 (1): 61–5. doi:10.2214/AJR.10.4459. PMID 21178047.
- ↑ Kutler DI, Moquete R, Kazam E, Kuhel WI (2011). "Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism". Laryngoscope. 121 (6): 1219–24. doi:10.1002/lary.21783. PMID 21557243.