Assessment of 4DCT imaging findings of parathyroid adenomas in correlation with biochemical and histopathological findings

• Published in: Japanese journal of radiology 2022-05, Vol.40 (5), p.484-491
• Main Authors: Gumeler, Ekim, Kurtulan, Olcay, Arslan, Sevtap, Karakaya, Jale, Sokmensuer, Cenk, Unluturk, Ugur, Oguz, Kader K., Akgoz Karaosmanoglu, Ayca
• Format: Article
• Language: English
• Subjects: Adenoma - diagnostic imaging; Adenoma - pathology; Four-Dimensional Computed Tomography; Humans; Imaging; Medicine; Medicine & Public Health; Middle Aged; Nuclear Medicine; Original Article; Parathyroid Hormone; Parathyroid Neoplasms - diagnostic imaging; Parathyroid Neoplasms - pathology; Radiology; Radiotherapy; Retrospective Studies
• ISSN: 1867-1071; 1867-108X
• DOI: 10.1007/s11604-021-01220-7

Purpose To assess polar vessel presence and enhancement 4DCT imaging and their relation with biochemical and histopathological features. Methods Patients with primary hyperparathyroidism and preoperative 4DCT imaging were screened retrospectively and those with histopathologically proven diagnosis of PA were included. Biochemical findings, densitometric measurements (HU precontrast, HU arterial , HU venous , HU wash-in , HU wash-out , HU retained ) and CT volume of PA on 4DCT, presence of a polar vessel (PV), and histopathological features were recorded. Correlations between serum PTH, calcium levels and densitometric measurements of PA on 4DCT were investigated. Differences between subgroups created according to PV presence were also evaluated. Results Thirty-nine patients were enrolled (F/M = 32/7, median age = 57, interquartile range = 50–62 years). In all patients, serum PTH levels positively correlated with CT volume ( r  = 0.398, p  = 0.012) but negatively correlated with HU arterial ( r  = − 0.366; p  = 0.022), HU venous ( r  = − 0.452; p  = 0.004) and HU retained ( r  = − 0.421; p  = 0.008). In PV (−) PAs, PTH levels were positively correlated with CT volume ( r  = 0.608, p  ≤ 0.002) and negatively with HU arterial ( r  = − 0.449, p  ≤ 0.028), HU venous ( r  = − 0.560, p  = 0.004), HU wash-in ( r  = − 0.460, p  = 0.024), and HU retained ( r  = − 0.539, p  = 0.007). No correlation between PTH levels and densitometric measurements was found in PV (+) PAs. HU wash-in and HU wash-out were significantly higher in PV (+) PAs compared to PV (−) PAs ( p  = 0.021 and p  = 0.033, respectively). Histopathologic features revealed no difference according to the presence of PV. Conclusion PTH levels might have an association with imaging findings of PAs, especially when categorized with respect to PV presence. PTH levels were negatively correlated with degree of enhancement in PV (−) PAs. Therefore, radiologists should be aware that in patients with high serum PTH levels and without a discernible PV, PA might be difficult to localize.