Background: Four-dimensional computed tomography (4D-CT) has emerged as a new technique for pre-operative localisation in patients with primary hyperparathyroidism (PHPT). Accurate localisation of parathyroid adenomas allows for minimally invasive parathyroidectomy in lieu of traditional bilateral neck exploration with lower complication rates.
Aims:
To evaluate the diagnostic performance of 4D-CTs compared with technetium 99m-sestamibi (sestamibi) SPECT/CT and neck ultrasound (US) for preoperative localisation in patients with histologically proven parathyroid adenomas and hyperplasia.
Methods:
This is a single-centre retrospective study of patients with PHPT who underwent US, sestamibi and 4D-CT from April 2018 to October 2022, with subsequent parathyroidectomy. Reference standard for correct localisation was based on operative reports and histopathological confirmation. Each modality was then analysed individually for its diagnostic accuracy.
Results:
A total of 18 patients were identified who underwent parathyroidectomy following US, sestamibi and 4D-CT. The overall sensitivity of US, sestamibi and 4D-CT with respect to operative findings were 44% and 44% and 67% respectively. 4D-CT scan was superior in localising parathyroid adenomas in patients without prior neck surgery compared to sestamibi and US. 4D-CT imaging was particularly useful for localising smaller adenomas or ectopic adenomas which were not identified by sestamibi and US.
Conclusion:
At our centre, 4D-CT localised parathyroid adenomas with higher sensitivity in patients with PHPT without a prior history of neck surgery, compared with sestamibi or US.