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4DCT Differentiation of Parathyroid Adenoma: A Case Report
Tana Bupe Mwewa1, Steven Raeymaeckers1
1UZ Brussel, Belgium.
Journal of the Belgian Society of Radiology
|August 21, 2023
Summary
Recurrent hyperparathyroidism after surgery can be challenging to locate. A novel multiphase 4DCT technique successfully identified a parathyroid adenoma missed by other imaging methods.
Area of Science:
- Endocrinology
- Nuclear Medicine
- Radiology
Background:
- Recurrent primary hyperparathyroidism presents a diagnostic challenge, particularly after prior thyroid and parathyroid surgery with autotransplantation.
- Standard imaging modalities like Methionine-PET-CT and Tc-99m-tetrofosmine SPECT/CT can yield false results in these complex cases.
Observation:
- A 72-year-old patient with recurrent hyperparathyroidism post-thyroidectomy and parathyroidectomy demonstrated false-positive Methionine-PET-CT and false-negative Tc-99m-tetrofosmine imaging.
- A novel multiphase 4DCT technique was employed to evaluate the persistent hyperparathyroidism.
Findings:
- Multiphase 4DCT identified an anterior mediastinal nodule with characteristic contrast enhancement patterns (wash-in and wash-out).
- This specific enhancement pattern, potentially missed by standard 4DCT protocols with fewer phases, indicated a parathyroid adenoma.
- Histopathology confirmed the resected nodule as a parathyroid adenoma.
Implications:
- Multiphase 4DCT offers a potentially valuable imaging approach for detecting recurrent or ectopic parathyroid adenomas in challenging post-surgical settings.
- This technique may improve diagnostic accuracy and guide surgical management for patients with persistent hyperparathyroidism after complex neck surgery.
