Localization of parathyroid adenomas: superselective arterial DSA versus superselective conventional angiography

A prospective comparison of superselective arterial digital subtraction angiography (DSA) and superselective conventional angiography (CA) was performed in a consecutive series of 26 patients with hyperparathyroidism, previous unsuccessful surgery, and single gland involvement. All patients had negative or inconclusive findings from noninvasive localization studies. Superselective studies included injection of both thyrocervical trunks, both internal mammary arteries, and both common carotid arteries in all patients in whom this was technically possible. DSA findings were true positive in 16 patients (62%); CA findings were true positive in ten patients (38%) and equivocal in four (15%) (P less than .046). There were no false-positive angiograms. DSA findings were positive in all patients in whom CA findings were positive or equivocal. Superselective DSA appears to be as sensitive as CA for preoperative parathyroid localization and may be more sensitive for the localization of mediastinal glands.