WHICH PATIENTS BENEFIT BEST FROM THE 4-DIMENSIONAL COMPUTED TOMOGRAPHY IMAGING FOR THE PRIMARY HYPERPARATHYROIDISM AS A SECOND-LINE IMAGING STUDY?

AUTHORS:
M. Kostek (Istanbul, Turkey) , C. Yanar (Istanbul, Turkey) , M.T. Unlu (Istanbul, Turkey) , O. Caliskan (Istanbul, Turkey) , N. Aygun (Istanbul, Turkey) , A. Gemalmaz (Istanbul, Turkey) , A. Ozel (Istanbul, Turkey) , M. Uludag (Istanbul, Turkey)
Background:
Minimal invasive parathyroidectomy has become the standard surgical operation in patients with Primary Hyperparathyroidism(PHPT). For preoperative localization of suspected adenoma, it is favorable to have positive results in at least two different imaging studies. In this study, diagnostic performance of 4-Dimensional Computed Tomography(4DCT) was evaluated in patients with PHPT as a second-line imaging study.
Methods:
Patients were operated for PHPT and underwent 4DCT between April, 2022 and November, 2023 were included to the study. Intraoperative findings, 4DCT results of patients together with USG and SPECT/CT results were evaluated retrospectively. Sensitivity and positive predictive value(PPV) were presented to evaluate diagnostic performance.
Results:
A total of 74 patients were evaluated. Findings of 4DCT were identified as true positive in 58 (78.3%) patients, false positive in 9(12.2%) patients, false negative in 6 (8.1%) patients and true negative in 1(1.4%) patient with multiglandular disease. Sensitivity and PPV of 4DCT were 86.6% (95% CI:77.1-93.3) and 90.6% (95% CI:81.9-96.2) in all patients, 96.6% (95% CI:85.7-99.8) and 90.3% (95% CI:76.8-97.5) in USG(+) and SPECT/CT(+) patients, 87.5% (95% CI:66.2-97.8) and 100% in USG(+) and SPECT/CT(-) patients, 91.7% (95% CI:68.1-99.5) and 84.6% (95% CI:59.6-97.3) in USG(-) and SPECT/CT(+) patients and 50% (95% CI:21.8-78.2) and 83.3% (95% CI:44.6-99.0) in USG(-) and SPECT/CT(-) patients.
Conclusions:
4DCT has high effectiveness in patients with at least one positive results from first-line imaging studies such as USG and SPECT/CT, however, in patients with negative results in both USG and SPECT/CT, sensitivity of 4DCT decreases and other advanced imaging techniques should be used to detect suspected gland preoperatively.