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Four-dimensional computed tomography (4D-CT) for preoperative parathyroid localization: A good study but are we using
Lindsay E Kuo1, Sarah H Bird2, Carrie C Lubitz3
1Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
American Journal of Surgery
|September 28, 2021
Summary
Four-dimensional computed tomography (4D-CT) is superior for locating abnormal parathyroid glands but is underutilized. Efforts to standardize 4D-CT use could enhance preoperative localization for hyperparathyroidism patients.
Area of Science:
- Endocrinology
- Surgical Oncology
- Radiology
Background:
- Four-dimensional computed tomography (4D-CT) offers superior diagnostic accuracy for localizing abnormal parathyroid glands compared to ultrasound (US) and sestamibi scans.
- The current implementation and utilization rates of 4D-CT for preoperative parathyroid imaging remain largely unknown.
Purpose of the Study:
- To assess the utilization patterns and institutional variability of 4D-CT in preoperative parathyroid localization.
- To compare the performance rates of 4D-CT against traditional imaging modalities like US and sestamibi.
Main Methods:
- Analysis of data from the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) database (2014-2018).
- Inclusion of patients undergoing initial surgery for hyperparathyroidism.
- Calculation of the performance rates for US, sestamibi, and 4D-CT across all institutions.
Main Results:
- Out of 7,959 included patients, 4D-CT was performed in only 20.4% (1,630 patients).
- Ultrasound (86.3%) and sestamibi (64.0%) were more frequently used, with the combination of US and sestamibi being most common (48.4%).
- Significant institutional variation in 4D-CT utilization was observed, ranging from 0.1% to 88.7%.
Conclusions:
- Four-dimensional computed tomography (4D-CT) is the least frequently utilized imaging modality for parathyroid localization.
- There is substantial variability in the application of 4D-CT across different institutions.
- Standardizing the use of 4D-CT may improve preoperative localization accuracy for patients with hyperparathyroidism.
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