title: The utility of multidetector computed tomography for detection of parathyroid disease in the setting of primary hyperparathyroidism.
abstract: OBJECTIVE
  The aim of this study was to evaluate the accuracy of multidetector computed tomography (MDCT) in the detection of parathyroid adenoma and hyperplasia in the setting of primary hyperparathyroidism.
  
  
  METHODS
  Records of 48 patients with biochemically confirmed primary hyperparathyroidism, who underwent preoperative imaging with 16- or 64-slice contrast-enhanced MDCT and subsequent successful parathyroidectomy over a 3-year period, were reviewed. Two radiologists, blinded to the operative and histologic findings, independently evaluated multiplanar computed tomographic images for all patients.
  
  
  RESULTS
  On pathologic examination, 63 abnormal glands were confirmed in 41 female and 7 male patients (mean age, 63 years). Of the 63 abnormal glands, 40 were adenomatous and 23 were hyperplastic. MDCT demonstrated an 88% (95% confidence interval [CI], 77%-99%) positive predictive value for localizing abnormal hyperfunctioning parathyroid glands. The sensitivity of MDCT in detecting single-gland disease was 80% (95% CI, 68%-92%); whereas the specificity for ruling out hyperfunctioning parathyroid tissue, either adenomatous or hyperplastic, was 75% (95% CI, 51%-99%). The sensitivity for exclusively localizing parathyroid hyperplasia was 17% (95% CI, 2%-33%). The parathyroid adenomas were substantially larger and heavier than their hyperplastic counterparts, with an average weight of 1.51 g (range, 0.08-6.00 g) and 0.42 g (range, 0.02-2.0 g) for adenoma and hyperplasia, respectively.
  
  
  CONCLUSIONS
  Contrast-enhanced MDCT demonstrated an 88% positive predictive value for localizing adenomatous and hyperplastic parathyroid glands. The poor sensitivity for detection of multigland disease was likely a result of the smaller size and weight of the abnormal hyperplastic glands.
authors.affiliation: Department of Radiology, McMaster University, Hamilton, Ontario, Canada. dorotadlinda@gmail.com
authors.forename: Dorota D
authors.initials: DD
authors.lastname: Linda
authors.forename: Bernard
authors.initials: B
authors.lastname: Ng
authors.forename: Ryan
authors.initials: R
authors.lastname: Rebello
authors.forename: Srinivasan
authors.initials: S
authors.lastname: Harish
authors.forename: George
authors.initials: G
authors.lastname: Ioannidis
authors.forename: J E M
authors.initials: JE
authors.lastname: Young
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*