BACKGROUND The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the 'gold standard'. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. METHODS An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. RESULTS All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78-94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53-76]; p < 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64-96) versus US and sestamibi (57% [95% CI 34-77]; p = 0.016). For adenomas < 1.0 g (n = 36; 48%), the accuracy of CT was 81% (95% CI 64-91) compared with 62% (95% CI 44-77) for US and sestamibi (p = 0.04). The correct preoperative diagnosis of multiglandular disease (n = 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14-73]) and US and CT (50% [95% CI 20-80]) (p > 0.99). CONCLUSION The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.

中文翻译：

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使用计算机断层扫描作为原发性甲状旁腺功能亢进患者的一线成像方式。

背景技术微创甲状旁腺切除术（MIP）的成功依赖于异常甲状旁腺的准确定位。超声 (US) 和 99mTc 闪烁显像 (sestamibi) 的一致结果目前被认为是“黄金标准”。最近，计算机断层扫描 (CT) 也被用于术前计划。我们试图评估 CT 在此类患者中定位异常甲状旁腺的准确性。方法 对 2017 年至 2019 年间在我中心接受颈部超声和 CT 作为一线影像学检查的 75 例原发性甲状旁腺功能亢进症 (PHPT) 患者进行审计。结果 所有 75 名患者均接受了 US 和 CT，54 名 (72.0%) 患者也接受了 sestamibi。仅 CT 就确定了所有患者的潜在靶点，其中 63 例（84.0%）位置正确。US 和 CT 的总体综合敏感性为 88% (95% CI 78-94)，高于 US 和 sestamibi 的综合敏感性 (65% [95% CI 53-76]；p < 0.001)。21 名患者 (28.0%) 有异位腺体，US 和 CT 的敏感性为 86% (95% CI 64-96)，而 US 和 sestamibi (57% [95% CI 34-77]; p = 0.016 ）。对于 < 1.0 g (n = 36; 48%) 的腺瘤，CT 的准确性为 81% (95% CI 64-91)，而 US 和 sestamibi 的准确性为 62% (95% CI 44-77) (p = 0.04) . 多发性腺病的正确术前诊断 (n = 9; 12%) 似乎是最困难的，US 和 sestamibi (40% [95% CI 14-73]) 以及 US 和 CT (50% [95]) 的准确度相似% CI 20-80]) (p > 0.99)。结论超声联合CT能够正确识别88%的患者甲状旁腺异常的位置，并且，与 US 和 sestamibi 相比，具有更好的诊断准确性，尤其是对于较小的异位腺瘤。这一发现表明，US 和 CT 可被视为考虑 MIP 的 PHPT 患者的一线成像方式。