The diagnostic utility of computed tomography for preoperative localization in surgery for hyperparathyroidism.
OBJECTIVE
Successful unilateral or minimal-access parathyroid exploration and reoperative surgery of the parathyroid glands requires accurate preoperative localization of parathyroid disease. Although ultrasound and nuclear imaging techniques have an established role in this regard, the use of computed tomography (CT) for parathyroid exploration is not well understood. The purpose of the present study was to better define the diagnostic utility of CT in preoperative localization of the abnormal gland in surgery for hyperparathyroidism.


METHODS
Retrospective cohort study.


METHODS
All parathyroid explorations performed at Oregon Health and Science University (Portland, OR) between 2000 and 2002 were reviewed. The study group was limited to patients with hyperparathyroidism in whom localization failed preoperatively using ultrasound and/or sestamibi scanning and subsequent investigation using CT imaging was performed. Operative, pathological, and imaging reports were then analyzed to assess the accuracy of CT imaging for localizing parathyroid disease.


RESULTS
Twenty-two patients with hyperparathyroidism were investigated preoperatively using CT imaging. Parathyroid exploration was successful in all but one patient, leaving 21 patients in all in the cohort. The majority of cases (67%) were reoperative, and all patients had previously undergone inconclusive ultrasound and/or sestamibi scanning. Computed tomography correctly localized parathyroid disease in 18 (86%) of the 21 patients who underwent successful extirpation of parathyroid disease and was able to identify abnormal glands with equal utility in the neck and the chest.


CONCLUSIONS
When ultrasound or sestamibi are unsuccessful, CT imaging can provide valuable preoperative localizing information before surgery for hyperparathyroidism, particularly in patients with recurrent or persistent disease.
Gross
Neil D
ND
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
Weissman
Jane L
JL
Veenker
Elizabeth
E
Cohen
James I
JI
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography