Preoperative computerized tomographic imaging in hyperparathyroidism

The surgery of hyperparathyroidism can be technically very difficult, even for an experienced surgeon. Until the present decade, preoperative localization procedures were of little help because of poor resolution of imaging modalities, significant morbidity, and the cost of invasive procedures. The efficacy of preoperative high-resolution CT scanning was evaluated in ten patients with primary hyperparathyroidism who had not previously been operated on. Contrast and noncontrast scans were performed on each patient, under the supervision of an experienced radiologist. Surgical findings were the standard against which all CT scans were judged. Each patient was diagnosed as having a single adenoma. Preoperative scans localized eight of ten adenomas for an overall sensitivity of 80 percent. In one patient, the adenoma was incorrectly localized for a specificity of 89 percent. The smallest adenoma correctly localized measured 4 x 4 mm in its axial dimensions. In addition to shortening operative time, accurate preoperative localization permitted use of unilateral dissection technique. Recent literature has repeatedly proved unilateral dissection superior to bilateral dissection by production of identical cure rates and a 2- to 12-fold decrease in postoperative hypocalcemia. We suggest that CT scanning be considered in the routine preoperative workup of patients who have primary hyperparathyroid disease.