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Objective
Evaluate the usefulness of a multiphasic dynamic contrast-enhanced computed tomography (4D CT) to identify enlarged parathyroid glands in patients with primary hyperparathyroidism that have an equivocal or negative Sestamibi scans. Positive 4DCT scans may improve the success rate of the minimally invasive parathyroidectomy.
Design
Retrospective review of patients with a biochemical diagnosis of primary hyperparathyroidism (PHPT) where a Sestamibi scan failed to accurately identify the offending gland. These patients underwent 4DCT scanning in hopes of allowing minimally invasive parathyroidectomy.
Setting
University affiliated private community institution.
Patient
Adult patients of both sexes.
Intervention
No intervention was done.
Main Outcome
Assess the accuracy and positive predictive value of the 4D CT scan to improve the success of minimally invasive surgery in the setting of a negative/equivocal Sestamibi scan for PHPT.
Results
Since the institution of the 4D CT scan at our institution in 2011, fifteen patients were evaluated. Nine had good correlation with the intraoperative findings, giving an accuracy value of 73% and a PPV of 70%. For the patients without correlation between the 4D CT and the intraoperative findings, we found that 50% were due to multiglandular disease. In 2 patients the 4D CT scans were obscured by artifact and were considered as negative scans. For these patients we were able to find a single adenoma during surgery and achieved subsequent biochemical cure.
Conclusions
The 4D CT scan is a new and accurate imaging tool for patients with PHPT and a negative or equivocal Sestamibi scan. This approach allows more patients to have minimally invasive parathyroidectomy.