The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT

Objectives: The major cause of primary hyperparathyroidism (pHPT) is parathyroid adenoma. Today, minimally invasive parathyroidectomy (MIP) has become the standard treatment for patients in whom the pathological gland can be localized with pre-operative imaging methods. In this study, we aimed to evaluate the role of 4D-CT in pre-operative localization in patients with pHPT who are negative for ultrasonography (USG) and/or sestamibi single-photon emission computed tomography/CT (SPECT/CT) and will undergo primary surgery.
Methods: Patients whom were operated between 2018 and 2023 were included to this study. 4D-CT results of patients with oneor two-negative USG and SPECT/CT results were evaluated retrospectively.
Results: In this study, 19 patients (5 men and 14 women) with a mean age of 57.1±8.5 years were evaluated. Pathology results were consistent with parathyroid adenoma in 18 patients (94.7%) and parathyroid hyperplasia in 1 patient (5.3%). USG was negative in six patients, SPECT/CT was negative in 14 patients, and both were negative in four patients. In 4D-CT, positive images were detected in 15 patients and these results were finalized as true positive in 14 patients and false positive in 1 patient. The sensitivity of 4DCT was 82.4% (95% CI: 60.4–95.3%), positive predictive value was 93.3% (95% CI: 73.8–99.6%), accuracy was 78.9%, and localization rate was 73.7%. In 14 (73.7%) patients, the pathological glands were removed by MIP.
Conclusion: In approximately 75% of patients with negative USG and/or SPECT/CT, the pathological gland can be localized with 4D-CT and MIP can be applied in these patients.

Ultrasonografi ve/veya Sestamibi SPECT/BT’nin Negatif Olduðu Primer Hiperparatiroidizmli Hastalarda Preoperatif Lokalizasyonda 4D-BT’nin Rolü

Giriþ: Primer hiperparatiroidizmin majör sebebi paratiroid adenomudur. Günümüzde preoperatif görüntüleme yöntemleri ile patolojik bezin lokalize edilebildiði hastalarda minimal invaziv paratiroidektomi(MIP) standart tedavi haline gelmiþtir. Bu çalýþmada ultrasonografi(USG) ve/veya sestamibi tek foton emisyon tomografi/Bilgisayarlý tomografi (SPECT/BT) negatif olan ve primer cerrahi uygulanacak pHPT’li hastalarda 4D-BT’nin preoperatif lokalizasyondaki rolünü deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: USG ve SPECT/CT’den biri veya ikisi negatif olan hastalara çekilen 4D-BT sonuçlarý retrospektif olarak deðerlendirildi.
Bulgular: Çalýþmada ortalama yaþ 57.1±8.5 olan 19 hastanýn 5 erkek, 14’ü kadýndý. Bu hastalarda patoloji sonuçlarý 18 hastada (94,7%) paratiroid adenomu, 1 hastada (5,3%) paratiroid hiperplazisi ile uyumluyu. Altý hastada USG negatif, 14 hastada SPECT/BT negatif, 4 hastada her ikisi de negatifti. 4D-BT’de 14 doðru pozitif, 1 yanlýþ pozitif olmak üzere 15 hastada pozitif görüntü saptandý. 4D-BT’nin sensitivitesi %82.4 (%95 CI: %60.4-%95.3), Pozitif Prediktif Deðer %93.3 (%95 CI: %73.8-%99.6), Uygunluk %78.9, Lokalizasyon Oraný: %73.7 idi. Hastalarýn 14’ünde (%73.7) minimal invaziv paratiroidektomi ile patolojik bez çýkarýldý.
Sonuç: USG ve sintigrafinin bir veya her ikisinin negatif olduðu hastalarýn yaklaþýk %75’inde 4D-BT ile patolojik bez lokalize edilebilir ve bu hastalarda MIP uygulanabilir. (SETB-2023-05-081)