Experience-informed interpretation of contrast-enhanced CT for parathyroid localization in Sestamibi-Negative Primary...

Accurate preoperative localization of the pathological parathyroid gland is critical for the success of minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (PHPT). Localization, however, remains challenging in patients with negative or non-localizing 99mTc-sestamibi scintigraphy (MIBI). This study evaluated whether experience-informed interpretation of contrast-enhanced neck computed tomography (CT) improves localization accuracy in this subgroup.

This retrospective study included PHPT patients who underwent parathyroidectomy between April 2021 and March 2025 and had negative or non-localizing MIBI findings. Preoperative contrast-enhanced neck CT scans interpreted using an experience-informed approach during preoperative planning were compared with standard radiologist CT reports and ultrasonography (US). Intraoperative findings served as the reference standard. Localization accuracy was compared using the McNemar test, with exact McNemar analysis performed for ectopic adenomas.

Fifty-four patients were included. MIP was successfully completed in 90.7% of cases. Localization accuracy was 48.1% for US, 57.4% for radiologist-interpreted CT, and 90.7% for experience-informed CT interpretation (p < 0.001). Experience-informed CT interpretation demonstrated a significantly higher likelihood of correct localization than standard radiology reports (odds ratio, 19.0; 95% confidence interval, 2.54-141.93). In patients with ectopic adenomas (n = 18), experience-informed CT interpretation achieved 100% localization accuracy compared with 66.7% for standard radiology reports (p = 0.031). No persistence or recurrence was observed during follow-up.

In scintigraphy-negative PHPT patients, experience-informed interpretation of contrast-enhanced CT significantly improves localization accuracy compared with standard radiology reporting and ultrasonography, and may support preoperative planning for minimally invasive parathyroidectomy in selected patients.