PRE-OPERATIVE LOCALIZATION OF PARATHYROID ADENOMA: PERFORMANCE OF 4D MRI PARATHYROID PROTOCOL.

Area of Science:

• Endocrinology
• Radiology
• Surgical Oncology

Background:

• Accurate pre-operative localization of parathyroid adenoma (PTA) is crucial for successful minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT).
• Conventional imaging techniques like sestamibi scan, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) have variable accuracy in PTA localization.
• Four-dimensional (4D) MRI has demonstrated superior accuracy in identifying single adenomas compared to conventional methods.

Purpose of the Study:

• To evaluate the accuracy of 4D MRI in localizing the specific quadrant of parathyroid adenomas (PTA) prior to surgery.
• To compare the efficacy of 4D MRI in distinguishing single-gland adenoma (SGA) from multi-gland disease (MGD).

Main Methods:

• Retrospective analysis of 26 patients with PHPT who underwent pre-operative 4D MRI localization.
• Matching of 4D MRI findings with intra-operative findings during parathyroidectomy.
• Assessment of successful resection based on intra-operative parathyroid hormone (IOPTH) levels meeting Miami criteria.

Main Results:

• 4D MRI accurately identified all single-gland adenomas (SGA) and double adenomas.
• Quadrant localization accuracy for SGA was 14 out of 18 patients.
• Overall accuracy of 4D MRI in distinguishing SGA from multi-gland disease (MGD) was 85%, with 67% accuracy for MGD identification.

Conclusions:

• 4D MRI is a highly accurate tool for localizing single and double parathyroid adenomas (PTA) in their respective quadrants.
• While effective for SGA, the accuracy of 4D MRI is reduced in cases of multi-gland disease (MGD).
• 4D MRI shows significant promise in improving surgical planning for PHPT treatment.