4D-Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism

• Published in: American journal of neuroradiology : AJNR 2020-03, Vol.41 (3), p.522-528
• Main Authors: Becker, J L, Patel, V, Johnson, K J, Guerrero, M, Klein, R R, Ranvier, G F, Owen, R P, Pawha, P, Nael, K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Editor's Choice; Female; Head & Neck; Humans; Hyperparathyroidism, Primary - diagnostic imaging; Hyperparathyroidism, Primary - surgery; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Imaging - methods; Male; Middle Aged; Parathyroidectomy - methods; Retrospective Studies; Surgery, Computer-Assisted - methods
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A6482

Our aim was to test the hypothesis that our recently introduced 4D-dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation. Inclusion criteria were the following: 1) confirmed biochemical diagnosis of primary hyperparathyroidism, 2) preoperative 4D-dynamic contrast-enhanced MR imaging, and 3) surgical cure with >50% decrease in serum parathyroid hormone intraoperatively. 4D-dynamic contrast-enhanced studies were reviewed independently by 2 neuroradiologists to identify the side, quadrant, and number of abnormal glands, and compared with surgical and pathologic results. Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease (9 with double-gland hyperplasia; 3 with 3-gland hyperplasia; and 5 with 4-gland hyperplasia). Interobserver agreement (κ) for the side (right versus left) was 0.92 for single-gland disease and 0.70 for multigland disease. Interobserver agreement for the quadrant (superior versus inferior) was 0.70 for single-gland disease and 0.69 for multigland disease. For single-gland disease, the gland was correctly located in 34/37 (92%) patients, with correct identification of the side in 37/37 (100%) and the quadrant in 34/37 (92%) patients. For multigland disease, the glands were correctly located in 35/47 (74%) patients, with correct identification of the side in 35/47 (74%) and the quadrant in 36/47 (77%). The proposed high spatial and temporal resolution 4D-dynamic contrast-enhanced MR imaging provides excellent diagnostic performance for preoperative localization in primary hyperparathyroidism, with correct gland localization of 92% for single-gland disease and 74% in multigland disease, superior to 4D-CT studies.