ISSN : 1302-7123 | E-ISSN : 1308-5123
The Medical Bulletin of Sisli Etfal Hospital
The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT [Med Bull Sisli Etfal Hosp]
Med Bull Sisli Etfal Hosp. 2023; 57(2): 238-244 | DOI: 10.14744/SEMB.2023.00907

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

Ceylan Yanar1, Mehmet Kostek2, Mehmet Taner Unlu2, Ozan Caliskan2, Burak Dincer2, Isik Cetinoglu1, Nurcihan Aygun2, Alper Ozel3, Ali Gemalmaz3, Mehmet Uludag2
1Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
2Division of Endocrine Surgery, Department of General Surgery, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye
3Department of Radiology, University of Health Sciences Türkiye, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Türkiye

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.

Keywords: 4D-CT, parathyroid adenoma, primary hyperparathyroidism

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

Ceylan Yanar1, Mehmet Kostek2, Mehmet Taner Unlu2, Ozan Caliskan2, Burak Dincer2, Isik Cetinoglu1, Nurcihan Aygun2, Alper Ozel3, Ali Gemalmaz3, Mehmet Uludag2
1Türkiye Sağlık Bilimleri Üniversitesi, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Genel Cerrahi Kliniği, İstanbul
2Türkiye Sağlık Bilimleri Üniversitesi, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Genel Cerrahi Ana Bilim Dalı, Endokrin Cerrahisi Bilim Dalı, İstanbul
3Türkiye Sağlık Bilimleri Üniversitesi, Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi, Radyoloji Ana Bilim Dalı, İstanbul

Giriş: Primer hiperparatiroidizmin majör sebebi paratiroid adenomudur. Günümüzde preoperatif görüntüleme yöntemleri ile patolojik bezin lokalize edilebildiği hastalarda minimal invaziv paratiroidektomi(MIP) standart tedavi haline gelmiştir. Bu çalışmada ultrasonografi(USG) ve/veya sestamibi tek foton emisyon tomografi/Bilgisayarlı tomografi (SPECT/BT) negatif olan ve primer cerrahi uygulanacak pHPT’li hastalarda 4D-BT’nin preoperatif lokalizasyondaki rolünü değerlendirmeyi amaçladık.
Gereç ve Yöntem: USG ve SPECT/CT’den biri veya ikisi negatif olan hastalara çekilen 4D-BT sonuçları retrospektif olarak değerlendirildi.
Bulgular: Çalışmada ortalama yaş 57.1±8.5 olan 19 hastanın 5 erkek, 14’ü kadındı. Bu hastalarda patoloji sonuçları 18 hastada (94,7%) paratiroid adenomu, 1 hastada (5,3%) paratiroid hiperplazisi ile uyumluyu. Altı hastada USG negatif, 14 hastada SPECT/BT negatif, 4 hastada her ikisi de negatifti. 4D-BT’de 14 doğru pozitif, 1 yanlış pozitif olmak üzere 15 hastada pozitif görüntü saptandı. 4D-BT’nin sensitivitesi %82.4 (%95 CI: %60.4-%95.3), Pozitif Prediktif Değer %93.3 (%95 CI: %73.8-%99.6), Uygunluk %78.9, Lokalizasyon Oranı: %73.7 idi. Hastaların 14’ünde (%73.7) minimal invaziv paratiroidektomi ile patolojik bez çıkarıldı.
Sonuç: USG ve sintigrafinin bir veya her ikisinin negatif olduğu hastaların yaklaşık %75’inde 4D-BT ile patolojik bez lokalize edilebilir ve bu hastalarda MIP uygulanabilir. (SETB-2023-05-081)

Anahtar Kelimeler: 4D-BT, paratroid adenomu, primer hiperparatiroidi

Ceylan Yanar, Mehmet Kostek, Mehmet Taner Unlu, Ozan Caliskan, Burak Dincer, Isik Cetinoglu, Nurcihan Aygun, Alper Ozel, Ali Gemalmaz, Mehmet Uludag. The Role of 4D-CT for Pre-Operative Localization in Patients with Primary Hyperparathyroidism with Negative Ultrasonography and/or Sestamibi SPECT/CT. Med Bull Sisli Etfal Hosp. 2023; 57(2): 238-244

Corresponding Author: Ceylan Yanar
Manuscript Language: English
LookUs & Online Makale