Localization Strategy Prior to Radiofrequency Ablation for Primary and Secondary Hyperparathyroidism

Area of Science:

• Endocrinology
• Radiology
• Nuclear Medicine

Background:

• Accurate preoperative localization of parathyroid lesions is essential for successful radiofrequency ablation (RFA) in patients with primary or secondary hyperparathyroidism.
• Current imaging protocols lack standardization, necessitating an evaluation of available diagnostic modalities.

Purpose of the Study:

• To assess and compare the diagnostic performance of ultrasound, four-dimensional computed tomography (4D-CT), and technetium 99m-sestamibi single-photon-emission-computed tomography/computed tomography (SPECT/CT) for preoperative localization in hyperparathyroidism prior to RFA.
• To identify optimal imaging strategies for improving RFA outcomes.

Main Methods:

• Retrospective analysis of 33 patients with primary or secondary hyperparathyroidism who underwent ultrasound, 4D-CT, and SPECT/CT before RFA.
• Evaluation of diagnostic performance using sensitivity, accuracy, and receiver operating characteristic curve analysis.

Main Results:

• Ultrasound demonstrated the highest sensitivity (0.953) and accuracy (0.943).
• Four-dimensional computed tomography (4D-CT) showed superior performance compared to SPECT/CT (sensitivity/accuracy: 0.929/0.920 vs. 0.741/0.716).
• Combined ultrasound and 4D-CT, as well as the combination of all three modalities, achieved the highest diagnostic performance (sensitivity 1.000, accuracy 0.989). Lesion length and volume significantly influenced the diagnostic performance of 4D-CT and SPECT/CT.

Conclusions:

• The combination of ultrasound and 4D-CT provides optimal preoperative localization for RFA in hyperparathyroidism.
• Parathyroid lesion size (length and volume) is a key factor affecting the diagnostic accuracy of 4D-CT and SPECT/CT.