Four-Dimensional Computed Tomography: Clinical Impact for Patients with Primary Hyperparathyroidism

Area of Science:

• Endocrinology
• Radiology
• Surgical Oncology

Background:

• Primary hyperparathyroidism (pHPT) management relies on accurate preoperative localization.
• Four-dimensional computed tomography (4DCT) has emerged as a potential imaging modality for pHPT localization.

Purpose of the Study:

• To evaluate the added value of 4DCT in localizing parathyroid adenomas in pHPT patients.
• To assess the impact of 4DCT introduction on surgical outcomes.

Main Methods:

• Retrospective cohort study (2004-2015) analyzing 536 parathyroid operations.
• 4DCT was utilized as a second-line imaging test since 2011 for patients with discordant sestamibi-SPECT (SeS) and ultrasound (US) findings.
• Surgical, histopathological, and biochemical data were collected.

Main Results:

• 4DCT demonstrated a sensitivity of 72.9% in patients with non-concordant SeS/US findings.
• 4DCT showed higher sensitivity in persistent/recurrent disease (60.0%) and multigland disease (67.4%) compared to SeS and US.
• No significant difference was observed in initial cure rates (95.4% vs. 95.9%) or minimally invasive parathyroidectomy rates (74.5% vs. 79.9%) between pre- and post-4DCT introduction eras.

Conclusions:

• 4DCT can be a valuable tool for surgical planning in specific pHPT cases, particularly when initial imaging is inconclusive.
• The implementation of 4DCT as a second-line localization study did not significantly alter overall cure rates or the adoption of minimally invasive procedures.
• Further research is warranted to explore the potential of 4DCT as a primary diagnostic tool for pHPT.