Interpretation of 4D CT for Parathyroid Localization—Retrospective Case Series

Abstract

Abstract

Introduction:

Patients referred with primary hyperparathyroidism undergo in-office surgeon-performed ultrasonography. Approximately two thirds of patients undergo additional localization with four-dimensional computed tomography for parathyroid localization (4D CT Parathyroid) being our preference. This study consists of three-dimensional CT planes (axial, sagittal, and coronal) with the fourth dimension being dynamic contrast enhancement with noncontrast, arterial phase, and venous phase series over time. We recently instituted a monthly interdepartmental radiology-endocrine surgery retrospective review of all cases of parathyroidectomy for which preoperative 4D CT Parathyroid was obtained. This exchange provides valuable feedback for the interpretation of the imaging in the context of the complete clinical picture.

Materials and Methods:

At a single institution large academic medical center, cases of parathyroidectomy with preoperative 4D CT Parathyroid are reviewed on a rolling monthly basis. As such, we have available the clinical presentation, ultrasonography findings, CT images and interpretation, intraoperative findings, intraoperative parathyroid hormone (PTH) measurements, and final pathologic analyses. A complete clinical picture is presented by the surgical service, then the radiologists review the images, and a retrospective interpretation is rendered. In this manner, imaging characteristics and unique cases are highlighted and bidirectional feedback is generated to improve subsequent interpretation for both the surgical and radiology teams.

Results:

A series of cases is used to demonstrate the imaging characteristics and interpretation of the spectrum of parathyroid disease, from single adenoma to multigland disease, including ectopic glands.

Conclusions:

Retrospective review of the imaging provides valuable feedback for both surgeon and radiologist interpretation of 4D CT for parathyroid localization. More definitive preoperative localization allows for an optimal surgical approach as well as a fully informed discussion with the patient regarding perioperative scenarios such as the likelihood of multigland disease, subtotal parathyroidectomy, or extraordinary dissection.

No competing financial interests exist.

Runtime of video: 8 mins 23 secs