Please use this identifier to cite or link to this item: http://hdl.handle.net/11434/1250
Title: Four-dimensional computed tomography: Clinical impact for patients with primary hyperparathyroidism.
Epworth Authors: Miller, Julie
Other Authors: Tian, Yuan
Tanny, Sharman Tan
Einsiedel, Paul
Lichtenstein, Meir
Stella, Damien
Phal, Pramit
Keywords: Four-dimensional computed tomography
4DCT
Hyperparathyroidism
Primary Hyperparathyroidism
pHPT
Parathyroid
Concordant sestamibi-SPECT
SeS
Multigland disease
Minimally invasive parathyroidectomy
Urorenal, Vascular Clinical Institute, Epworth HealthCare, Victoria, Australia
Epworth Medical Imaging, Victoria, Australia
Cancer Services Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Oct-2017
Publisher: Springer International Publishing
Citation: Ann Surg Oncol. 2017 Oct 23.
Abstract: BACKGROUND: In recent years, four-dimensional computed tomography (4DCT) has emerged as a new localization study for primary hyperparathyroidism (pHPT). OBJECTIVE: We aimed to assess the added value of 4DCT in our institution in the first 4 years of use. METHODS: A retrospective cohort study was conducted from February 2004 to June 2015. Since 2011, patients over 50 years of age without concordant sestamibi-SPECT (SeS) and ultrasound (US) findings underwent 4DCT. Imaging results, surgical findings, histopathology, and postoperative biochemistry were collected. RESULTS: A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22). CONCLUSION: Parathyroid 4DCT can aid surgical planning in cases without concordant SeS/US findings; however, the introduction of 4DCT as a second-line test did not change our overall cure rate or rate of minimally invasive parathyroidectomy. The role of 4DCT as the primary localization study for pHPT merits further investigation.
URI: http://hdl.handle.net/11434/1250
DOI: 10.1245/s10434-017-6115-9
PubMed URL: https://www.ncbi.nlm.nih.gov/pubmed/29063298
ISSN: 1068-9265
1534-4681
Journal Title: Annals of Surgical Oncology
Type: Journal Article
Affiliated Organisations: Endocrine Surgery Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
Endocrine Surgery Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
Department of Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, Australia.
Department of Radiology, University of Melbourne, Parkville, VIC, Australia.
Endocrine Surgery Unit, Royal Melbourne Hospital, Parkville, VIC, Australia.
Department of Surgery, University of Melbourne, Parkville, VIC, Australia.
Type of Clinical Study or Trial: Cohort Study
Appears in Collections:Cancer Services
Diagnostic Services
UroRenal, Vascular

Files in This Item:
There are no files associated with this item.


Items in EKB are protected by copyright, with all rights reserved, unless otherwise indicated.