MRI and 4D-CT Diagnostic Pprformance in pre-Operative Localization of Parathyroid Adenoma among Primary Hyperparathyroidism Patients Correlated to Pathological Findings
2Endocrine Surgery Service, Medical & Research Development, Rambam Health Care Center, Israel
3Radiology Departement, Galilee Medical Center, Western Galilee hospital - Nahariya, Israel
Purpose: Evaluate the diagnostic performance of 3T MRI in comparison with 4D CT for presurgical localization of parathyroid adenomas.
Accurate localization of an abnormal hyperfunctioning gland is critical in planning the surgical approach in patients with primary hyperparathyroidism. Magnetic resonance imaging (MRI), 4D computed tomography (4D CT), ultrasound (US), and 99mTc-sestamibi scan have all been shown to have high diagnostic performance for this purpose. Both 4D CT and MRI are able to give a diagnosis together with a good demonstration of related anatomy. MRI has the advantage of using non-ionizing radiation and causing fewer allergies to intravenous contrast.
Methods: A Prospective single-center study was conducted. Patients with a clinical and laboratory diagnosis of hyperparathyroidism completed both a dynamic MRI and a 4D CT scan. The images were evaluated by a neuroradiologist and later correlated with surgical outcomes. Any other imaging data available (99mTc-sestamibi scan or US) were also recorded and analyzed.
Results: Twenty-one hyperfunctioning glands were surgically proven. Eighteen of which were detected by MRI with no false-positive results (sensitivity 85.7%, PPV 100%). Sixteen adenomas were detected by 4D CT, with one suspected lesion surgically proven to be a normal parathyroid gland (Sensitivity 76.2%, PPV 94.2%). Two of the adenomas not apparent on MRI were detected on 4D CT, while 4 adenomas were detected by MRI alone. When combining the methods, The sensitivity rose to 87.0%.
Conclusio: Our study suggests that both MRI and 4D CT are good diagnostic tools in the case of hyperparathyroidism. Combining the methods may be of benefit.