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The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism

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Abstract

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.

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Authors and Affiliations

  1. Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK

    Mechteld C. de Jong, K. Jamal, V. Rozalén García, M. Shawky, T. E. Abdel-Aziz & T. R. Kurzawinski

  2. Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK

    S. Morley, T. Beale, S. Jawad & S. Otero

  3. Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK

    T. Chung, S. Hurel, H. Simpson, U. Srirangalingam & S. E. Baldeweg

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  1. Mechteld C. de Jong
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Contributions

MC de Jong: Study conception and design; acquisition, analysis, and interpretation of data; drafting of manuscript.

K Jamal: Study conception and design; acquisition of data; critical revision.

S Morley: Acquisition of data; analysis and interpretation of data.

T Beale: Acquisition of data; analysis and interpretation of data.

T Chung: Study conception and design; acquisition of data; analysis and interpretation of data.

S Jawad: Acquisition of data; analysis and interpretation of data.

S Hurel: Acquisition of data; analysis and interpretation of data.

H Simpson: Acquisition of data; analysis of data.

U Srirangalingam: Acquisition of data; analysis of data.

SE Baldeweg: Critical revision of revised manuscript.

V Rozalén García: Acquisition of data; analysis and interpretation of data.

S Otero: Acquisition of data; analysis of data.

M Shawky: Acquisition of data; analysis and interpretation of data.

TE Abdel-Aziz: Study conception and design; critical revision.

TR Kurzawinski: Analysis and interpretation of data; drafting of manuscript.

Corresponding author

Correspondence to Mechteld C. de Jong.

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The authors declare that they have no conflict of interest.

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All procedures performed in this study were in accordance with the ethical standards of our institution and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This retrospective study was registered as an audit of our current practice with our IRB and was exempt from review.

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Not applicable; anonymized retrospective data analysis, consent requirement waived.

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de Jong, M.C., Jamal, K., Morley, S. et al. The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism. Hormones 20, 499–506 (2021). https://doi.org/10.1007/s42000-020-00205-x

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