SavedAdd your journal

Journals / Meandros Medical And Dental Journal / 2025 / Volume: 26 Issue: 4

The Role of Four-Dimensional Computed Tomography in Primary Hyperparathyroidism with Non-Localizing or Discordant Standard Imaging

Standart Görüntüleme Yöntemleri ile Lokalize Edilemeyen veya Uyumsuz Sonuçlar Elde Edilen Primer Hiperparatiroidili Olgularda Dört Boyutlu Bilgisayarlı Tomografi'nin Yeri

Nagihan Kolkıran(MANİSA CELÂL BAYAR ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, TIBBİ ONKOLOJİ BİLİM DALI)0000-0001-9344-7212
Nilüfer Özdemir(MANİSA CELÂL BAYAR ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ENDOKRİNOLOJİ VE METABOLİZMA BİLİM DALI)0000-0002-0719-988X
Yüksel Pabuşçu(MANİSA CELÂL BAYAR ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYOLOJİ ANABİLİM DALI)0000-0002-5854-7573
Zeliha Hekimsoy(MANİSA CELÂL BAYAR ÜNİVERSİTESİ, TIP FAKÜLTESİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, İÇ HASTALIKLARI ANABİLİM DALI, ENDOKRİNOLOJİ VE METABOLİZMA BİLİM DALI)0000-0002-6003-0485
Pages
—
Publication Date
2025-12-25
🏛️Bibliographic metadata and full text access for this article are provided via DergiPark.
DergiPark Record ↗
✨

AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

In cases with primary hyperparathyroidism, 4DCT is able to accurately detect and localize these lesions hence providing a chance for cure by surgical resection.

📌 3 Key Takeaways

🎯
Objective & Hypothesis:Objective: Four-dimensional computed tomography (4DCT) demonstrates superior diagnostic capability in localizing parathyroid adenomas that are non-detectable by conventional ultrasonography (USG) or scintigraphy. 4D-CT demonstrates particular utility in spatial differentiation, allowing precise localization of adenomas while distinguishing them from adjacent thyroid tissue and lymphatic structures.
📊
Key Findings & Data:This study evaluated the accuracy of 4D-CT for localizing parathyroid adenomas in primary hyperparathyroidism patients with non-diagnostic or conflicting ultrasound and sestamibi scan results.
💡
Conclusion & Impact:In cases with primary hyperparathyroidism, 4DCT is able to accurately detect and localize these lesions hence providing a chance for cure by surgical resection.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:Primary Hyperparathyroidism · Four-Dimensional Computed Tomography · ultrasonography

Abstract

Objective: Four-dimensional computed tomography (4DCT) demonstrates superior diagnostic capability in localizing parathyroid adenomas that are non-detectable by conventional ultrasonography (USG) or scintigraphy. 4D-CT demonstrates particular utility in spatial differentiation, allowing precise localization of adenomas while distinguishing them from adjacent thyroid tissue and lymphatic structures. This study evaluated the accuracy of 4D-CT for localizing parathyroid adenomas in primary hyperparathyroidism patients with non-diagnostic or conflicting ultrasound and sestamibi scan results. Materials and Methods: This prospective study enrolled 25 patients with primary hyperparathyroidism whose parathyroid adenomas either could not be localized by either ultrasonography or scintigraphy or showed discordant imaging results between the two modalities. A 4DCT scan was performed for each of the 25 study participants diagnosed with primary hyperparathyroidism. The diagnostic findings of USG, scintigraphy, and 4DCT were correlated with histopathological results. Results: 4DCT demonstrated 100% detection sensitivity, markedly superior to ultrasonography's 68% and scintigraphy's mere 12%. For lateralization, 4DCT achieved 92% sensitivity versus ultrasonography's 88% and scintigraphy's notably poorer 33%. In precise localization, four-dimensional computed tomography's 80% accuracy exceeded ultrasonography's 64%, while scintigraphy demonstrated a complete inability to localize lesions. Conclusion: In our study, 4DCT was found to be the most sensitive method for detection, lateralization, and localization of parathyroid adenomas compared to USG and scintigraphy. In cases with primary hyperparathyroidism, 4DCT is able to accurately detect and localize these lesions hence providing a chance for cure by surgical resection.

🔖

Cite This Article

Kolkıran, N., Özdemir, N., Pabuşçu, Y., Hekimsoy, Z. (2025). The Role of Four-Dimensional Computed Tomography in Primary Hyperparathyroidism with Non-Localizing or Discordant Standard Imaging. Meandros Medical And Dental Journal, Volume: 26 Issue: 4. https://doi.org/10.69601/meandrosmdj.1693139

📄 Full Text PDF Viewer

📄

PDF görüntüleyici hazırlanıyor...

References (25)

  1. Ellika S, Patel S, Aho T, Marin H. Preoperative localization of parathyroid adenomas using 4-dimensional computed tomography: a pictorial essay. Can Assoc Radiol J 2013;64(3):258–68.
  2. Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GEH, Marcocci C, Minisola S, et al. Evaluation and management of primary hyperparathyroidism: summary statement and guidelines from the fifth international workshop. J Bone Miner Res. 2022; 37:2293–314.
  3. The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism. Endocr Pract. 2005;11(1):49–54.
  4. Fraser WD. Hyperparathyroidism. Lancet. 2009;374(9684):145–58.
  5. Vu TH, Guha-Thakurta N, Harrell RK, Ahmed S, Kumar AJ, Johnson VE, et al. Imaging characteristics of hyperfunctioning parathyroid adenomas using multiphase multidetector computed tomography: a quantitative and qualitative approach. J Comput Assist Tomogr. 2011;35(5).
  6. Matthews C, Matthews A, Safavi K. Four-dimensional computed tomography–future of preoperative parathyroid adenoma imaging. Ochsner J. 2017;17(3):220–2.
  7. Dobreva EA, Gorbacheva AM, Bibik EE, Eremkina AK, Elfimova AR, Salimkhanov RK, et al. Cardiovascular and metabolic status in patients with primary hyperparathyroidism: a single-center experience. Front Endocrinol (Lausanne). 2023;14.
  8. Erickson LA, Mete O, Juhlin CC, Perren A, Gill AJ. Overview of the 2022 WHO classification of parathyroid tumors. Endocr Pathol. 2022; 33:64–89.
  9. Raghavan P, Durst CR, Ornan DA, Mukherjee S, Wintermark M, Patrie JT, et al. Dynamic CT for parathyroid disease: are multiple phases necessary? AJNR Am J Neuroradiol. 2014;35(10):1959–64.
  10. Lundstroem AK, Trolle W, Soerensen CH, Myschetzky PS. Preoperative localization of hyperfunctioning parathyroid glands with 4D-CT. Eur Arch Otorhinolaryngol. 2016;273(5):1253–9.
  11. Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 2006;140(6):932–41.
  12. Hunter GJ, Schellingerhout D, Vu TH, Perrier ND, Hamberg LM. Accuracy of four-dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Radiology. 2012;264(3):789–95.
  13. Chazen JL, Gupta A, Dunning A, Phillips CD. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol. 2012;33(3):429–33.
  14. Mekel M, Mahajna A, Ish-Shalom S, Barak M, Segal E, Salih AA, et al. Minimally invasive surgery for treatment of hyperparathyroidism. Isr Med Assoc J. 2005;7(5):323–7.
  15. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012; 19:577–83.
  16. Terris DJ, Stack BC, Gourin CG. Contemporary parathyroidectomy: exploiting technology. Am J Otolaryngol. 2007;28(6):408–14.
  17. Hinson AM, Lee DR, Hobbs BA, Fitzgerald RT, Bodenner DL, Stack BCJ. Preoperative 4D CT localization of nonlocalizing parathyroid adenomas by ultrasound and SPECT-CT. Otolaryngol Head Neck Surg. 2015;153(5):775–8.
  18. Solorzano CC, Carneiro-Pla DM, Irvin GL 3rd. Surgeon-performed ultrasonography as the initial and only localizing study in sporadic primary hyperparathyroidism. J Am Coll Surg. 2006;202(1):18–24.
  19. Ghaheri BA, Koslin DB, Wood AH, Cohen JI. Preoperative ultrasound is worthwhile for reoperative parathyroid surgery. Laryngoscope. 2004;114(12):2168–71.
  20. Kluijfhout WP, Pasternak JD, Beninato T, Drake FT, Gosnell JE, Shen WT, et al. Diagnostic performance of computed tomography for parathyroid adenoma localization: a systematic review and meta-analysis. Eur J Radiol. 2017; 88:117–28.
  21. Lubitz CC, Hunter GJ, Hamberg LM, Parangi S, Ruan D, Gawande A, et al. Accuracy of 4-dimensional computed tomography in poorly localized patients with primary hyperparathyroidism. Surgery. 2010;148(6):1128–9.
  22. Galvin L, Oldan JD, Bahl M, Eastwood JD, Sosa JA, Hoang JK. Parathyroid 4D CT and scintigraphy: what factors contribute to missed parathyroid lesions? Otolaryngol Head Neck Surg. 2016;154(5):847–53.
  23. Hoang JK, Reiman RE, Nguyen GB, Januzis N, Chin BB, Lowry C, et al. Lifetime attributable risk of cancer from radiation exposure during parathyroid imaging: comparison of 4D CT and parathyroid scintigraphy. AJR Am J Roentgenol. 2015;204(5): W579–85.
  24. Bahl M, Sepahdari AR, Sosa JA, Hoang JK. Parathyroid adenomas and hyperplasia on four-dimensional CT scans: three patterns of enhancement relative to the thyroid gland justify a three-phase protocol. Radiology. 2015;277(2):454–62.
  25. Noureldine SI, Aygun N, Walden MJ, Hassoon A, Gujar SK, Tufano RP. Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: how many phases do we really need? Surgery. 2014;156(6):1300–7.