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Objective: Evaluate the reliability of four dimension computed tomography (4D-CT) in localizing hyperplastic parathyroid glands when Sestamibi-SPECT is negative in patients with hyperparathyroidism.
Design: Sequential cohort.
Setting: Endocrine Surgery in a community hospital.
Patients: 36 consecutive patients referred to Surgical Endocrinology clinic for management of hyperparathyroidism, 2011-2012.
Interventions: All patients underwent Sestamibi-SPECT. Those with unidentifiable hyperplastic parathyroid glands subsequently underwent 4D-CT. Following preoperative localization imaging all patients underwent parathyroid exploration.
Main Outcome Measure: Correlation of 4D-CT results on patients with negative Sestamibi-SPECT and intra-operative findings was noted.
Results: All 36 patients referred to Endocrine Surgery underwent Sestamibi-SPECT. 6 of these patients had a negative Sestamibi-SPECT and subsequently underwent 4D-CT. 35 parathyroid adenomas were found; and 1 patient had normal results on both Sestamibi-SPECT and 4D-CT that correlated with intra-operative findings. The sensitivity for localization for Sestamibi-SPECT imaging was 85% (30/35). The sensitivity for quadrant localization for 4D-CT was 100% (5/5) with 100% accuracy (6/6).
Conclusions: The high sensitivity of 4D-CT in this small series makes it a reliable tool for preoperative localization of hyperplastic parathyroid glands when Sestamibi-SPECT imaging is negative.