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The Parathyroid Glands

The Parathyroid Glands

The two pairs of parathyroid glands embedded within the posterior surface of the thyroid gland are restricted by a dense capsule around them. These glands comprise two distinct cell populations—parathyroid oxyphil and parathyroid principal cells- pivotal in calcium homeostasis.
Oxyphil cells, whose functions remain elusive, emerge during late puberty, adding a layer of complexity to the parathyroid gland's intricacies. In contrast, principal parathyroid cells undertake a vital role by...

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Correlation between 4D-CT Enhancement Patterns and Parathyroid Adenoma Cellularity: A Retrospective Study.

Vineet V Gorolay^1,2,3,4, Yannan Yu⁵, Ngoc-Anh Tran⁵

¹From the Department of Radiology (V.V.G.), Royal North Shore Hospital, Sydney, New South, Australia.

AJNR. American Journal of Neuroradiology

|November 7, 2025

Summary

Type A enhancement on four-dimensional computed tomography (4DCT) is linked to increased cellularity in parathyroid adenomas. This suggests 4DCT enhancement patterns can predict histologic features, aiding surgical planning.

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Area of Science:

Radiology and Imaging
Endocrinology
Surgical Pathology

Background:

Four-dimensional computed tomography (4DCT) is standard for parathyroid adenoma localization.
The correlation between 4DCT enhancement patterns and parathyroid adenoma histology, specifically cellularity, is not well understood.
Understanding this relationship can refine preoperative assessment.

Purpose of the Study:

To investigate the association between 4DCT enhancement patterns and lesion cellularity in surgically confirmed parathyroid adenomas.
To determine if 4DCT enhancement can serve as a surrogate marker for histologic features.
To enhance preoperative planning and surgical decision-making for parathyroid adenomas.

Main Methods:

Retrospective analysis of 121 parathyroid lesions from 95 patients who underwent 4DCT and parathyroidectomy.
Lesions were categorized by enhancement pattern (Type A, B, C) and cellularity (increased vs. non-increased, 80% cutoff).
Mixed-effect logistic regression was used to analyze the association between enhancement patterns and cellularity, adjusting for confounders.

Main Results:

Type A enhancement was significantly associated with increased cellularity (OR 6.1, p=0.02).
Larger lesion size also predicted increased cellularity (p<0.001).
No significant correlation was found between Type B or C enhancement and cellularity.

Conclusions:

Type A enhancement on 4DCT is an independent predictor of increased cellularity in parathyroid adenomas.
4DCT enhancement kinetics may offer valuable insights into histologic characteristics.
These findings support the use of 4DCT enhancement patterns for improved preoperative evaluation and surgical guidance.