Current Meeting Home Final Program Past & Future Meetings

Back to 2015 Annual Meeting Posters


Diagnostic Accuracy of Modified Low-Dose Four-Dimensional Computed Tomography for Preoperative Localization in Patients with Primary Hyperparathyroidism
*Courtney E Quinn, *Amit Mahajan, *Neeta J Erinjeri, *Taylor C Brown, *Jennifer Malinowski, *Glenda G Callender, Robert Udelsman, *Tobias Carling
Yale University School of Medicine, New Haven, CT

Objective: Primary hyperparathyroidism (PHPT) is common and amendable to curative parathyroidectomy. Four-dimensional computed tomography (4DCT) has demonstrated efficacy in the pre-operative identification of culprit lesion(s). While highly accurate, with sensitivity of 93.9%, 4DCT exposes patients to higher radiation doses than other imaging modalities. In 2012, our institution introduced a low-dose, 4DCT, by switching from a 5-phase to a 3-phase scan and reducing the kVp from 140 to 120 kV. The objective of this study is to assess the accuracy of low-dose 4DCT in the preoperative localization of abnormal parathyroid glands.
Design: Retrospective analysis of prospective database.
Setting: Tertiary academic referral center.
Patients: From April 2012 through December 2014, 933 patients with PHPT underwent parathyroidectomy. Of these, 404 had low-dose 4DCT imaging for localization.
Interventions: Low-dose 4DCT was instituted uniformly with a single radiologist interpreting these studies. Parathyroidectomy was performed using intra-operative intact parathyroid hormone (ioPTH) monitoring.
Main Outcome Measure(s): Low-dose 4DCT imaging reports were reviewed to determine pre-operative localization of abnormal gland(s). Operative and pathology reports were reviewed to determine anatomical position of the lesion(s) and to determine sensitivity and positive predictive value (PPV) of low-dose 4DCT.
Results: PHPT was due to single adenoma in 64.6% and multigland disease (MGD) in 35.1%. Overall sensitivity and PPV of low-dose 4DCT were 79.6% and 89.1%, respectively. Sensitivity and PPV for single adenoma were 98.3% and 88.8%, respectively. For MGD, sensitivity and PPV were 47.4% and 90.1%, respectively. Low-dose 4DCT has an effective dose reduction from 30mSv to 13.2mSv.
Conclusions: Low-dose 4DCT can reliably localize culprit lesions in patients presenting with PHPT caused by single gland disease, with comparable sensitivity to standard 4DCT, and decreased radiation exposure.


Back to 2015 Annual Meeting Posters


© 2021 New England Surgical Society. All Rights Reserved. Privacy Policy.