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A Novel Method: Super-selective Adrenal Venous Sampling

A Novel Method: Super-selective Adrenal Venous Sampling

Published on: September 15, 2017

Adenoma localization for recurrent or persistent primary hyperparathyroidism using dynamic four-dimensional CT and

Michael Ginsburg¹, Gregory A Christoforidis¹, Sean P Zivin²

¹Division of Neurointerventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois.

Journal of Vascular and Interventional Radiology : JVIR

|December 3, 2014

Summary

Parathyroid venous sampling combined with 4D CT significantly improves localization of parathyroid adenomas in patients with persistent primary hyperparathyroidism. This combination enhances diagnostic accuracy for recurrent disease when initial scans are negative.

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Area of Science:

Endocrinology
Radiology
Surgical Oncology

Background:

Recurrent or persistent primary hyperparathyroidism (pHPT) poses diagnostic challenges, especially when initial imaging like technetium-99m methoxyisobutyl isonitrile ((99m)Tc-MIBI) scans and ultrasound (US) are negative.
Accurate localization of parathyroid adenomas is crucial for successful surgical intervention, particularly in repeat surgeries.

Purpose of the Study:

To evaluate the efficacy of combining parathyroid venous sampling (PVS) with four-dimensional computed tomography (4D CT) for identifying parathyroid adenomas.
To assess if this combined approach improves sensitivity and accuracy in patients with recurrent or persistent pHPT and negative initial imaging.

Main Methods:

A study involving 28 patients with recurrent or persistent pHPT and negative (99m)Tc-MIBI and US scans.
Both PVS and 4D CT were performed, with localization assessed by 4D CT alone, PVS alone, and the combination.
Correlation with surgical outcomes was retrospectively analyzed.

Main Results:

The combination of 4D CT and PVS increased sensitivity from 50% to 95% (P = .004) and accuracy from 55% to 91% (P = .022) compared to 4D CT alone.
PVS alone demonstrated a sensitivity of 93.3% for lateralization.
Surgery confirmed the findings, identifying multiple parathyroid adenomas, a carcinoma, and hyperplastic glands.

Conclusions:

Parathyroid venous sampling significantly enhances the localization capabilities of 4D CT for parathyroid adenomas.
The combined PVS and 4D CT approach is highly effective in guiding surgery for patients with recurrent or persistent pHPT when initial imaging is inconclusive.