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Establishment of a Simple and Effective Rat Model for Intraoperative Parathyroid Gland Imaging

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4DCT Scanning Technique for Primary Hyperparathyroidism: A Scoping Review.

Steven Raeymaeckers¹, Maurizio Tosi¹, Johan De Mey^1,2

¹Universitair Ziekenhuis Brussel, Laarbeeklaan 101, Jette 1090, Belgium.

Radiology Research and Practice

|June 7, 2021

Summary

This review summarizes 4D CT protocols for detecting parathyroid adenomas. A triphasic approach is recommended for optimal sensitivity and specificity, with lower tube voltage potentially reducing radiation dose.

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Area of Science:

Radiology
Medical Imaging
Endocrinology

Background:

Four-dimensional computed tomography (4DCT) is crucial for managing primary hyperparathyroidism by detecting enlarged parathyroid glands.
Existing 4DCT protocols for parathyroid adenoma detection are highly variable across institutions.

Purpose of the Study:

To review and synthesize diverse 4DCT scanning protocols used for parathyroid adenoma detection.
To evaluate the reported sensitivity, specificity, and radiation dose associated with various 4DCT protocols.

Main Methods:

A comprehensive literature search was conducted using MEDLINE from April to May 2020.
Two radiologists independently screened articles, assessed eligibility, and extracted data on scanning parameters and diagnostic performance.

Main Results:

Fifty-one articles identified 56 distinct 4DCT protocols, predominantly using three (n=25) or four (n=23) phases.
Mean sensitivity was 81.5% and mean specificity was 86%, with reported effective doses up to 28 mSv.
Non-contrast imaging and an arterial phase (25-30s post-contrast) were common; venous phase timing varied. Contrast administration averaged 100 mL at 3-4 mL/s, with limited use of bolus tracking.

Conclusions:

Numerous 4DCT protocols exist for parathyroid adenoma detection, with no clear impact of phase number on diagnostic accuracy.
A triphasic protocol appears advantageous due to described enhancement patterns, and bolus tracking may improve consistency.
Scan parameters like tube voltage/current and dose reduction strategies (e.g., lower tube voltage, fixed tube current) warrant consideration without compromising sensitivity/specificity.