Four-dimensional computed tomography as first-line imaging in primary hyperparathyroidism, a retrospective comparison to conventional imaging in a predominantly single adenoma population

• Published in: EJNMMI reports 2024-05, Vol.8 (1), p.11-11, Article 11
• Main Authors: Krol, Jorian P, Joosten, Frank B M, de Boer, Hans, Bernsen, Marie Louise E, Slump, Cornelis H, Oyen, Wim J G
• Format: Article
• Language: English
• Subjects: Adenoma; Computed tomography; Fluorine isotopes; Hyperparathyroidism; Localization; Medical imaging; Parathyroid; Parathyroidectomy; Patients; Positron emission; Sensitivity; Single photon emission computed tomography; Tumors; Ultrasonic imaging; Ultrasound
• ISSN: 3005-074X; 3005-074X; 2510-3636
• DOI: 10.1186/s41824-024-00198-5

To determine the use of four-dimensional CT as first-line imaging compared to the traditional combination of ultrasound and [ Tc]Tc-Sestamibi SPECT. Retrospective review of preoperative imaging in patients with primary hyperparathyroidism, who underwent parathyroidectomy between 2012 and 2021. In one group, the combination ultrasound and [ Tc]Tc-Sestamibi SPECT was used as first-line imaging (n = 54), in the other group four-dimensional CT was the first-line imaging modality (n = 51). Sensitivity and positive predictive value were calculated on patient, lateralisation and localisation level. The need for additional imaging was also assessed for both groups. Four-dimensional CT had a significantly higher sensitivity compared to the combination of ultrasound/[ Tc]Tc-Sestamibi SPECT on patient and localisation level (70.6% vs. 51.9%, p = 0.049 and 60.8% vs. 35.2%, p = 0.009 respectively). Sensitivity for lateralisation also appeared higher, but did not reach significance (62.7% vs. 44.4%, p = 0.060). Positive predictive value was not significantly higher for four-dimensional CT compared to ultrasound and [ Tc]Tc-Sestamibi SPECT (88.9% vs. 85.7% for lateralisation and 86.1% vs. 67.9% for localisation respectively). Additional imaging was required in 14 patients with four-dimensional CT as first-line imaging (27.4%) consisting of 2 ultrasound/[ Tc]Tc-Sestamibi SPECT and 13 [ F]fluorocholine PET/CT, compared to 24 patients with ultrasound/[ Tc]Tc-Sestamibi SPECT as first-line imaging (44.4%), requiring 22 four-dimensional CT and 9 [ F]fluorocholine PET/CT. Four-dimensional CT as the sole first-line parathyroid imaging modality had higher sensitivity than the combination of ultrasound and [ Tc]Tc-Sestamibi SPECT, therefore requiring fewer additional procedures. Although the most costly, [ F]fluorocholine PET/CT was the most effective technique to localise parathyroid adenoma in case all other imaging was negative.