title: Discriminating parathyroid adenoma from local mimics by using inherent tissue attenuation and vascular information obtained with four-dimensional CT: formulation of a multinomial logistic regression model.
abstract: OBJECTIVE
  To identify a set of parameters, which are based on tissue enhancement and native iodine content obtained from a standardized triple-phase four-dimensional (4D) computed tomographic (CT) scan, that define a multinomial logistic regression model that discriminates between parathyroid adenoma (PTA) and thyroid nodules or lymph nodes.
  
  
  METHODS
  Informed consent was waived by the institutional review board for this retrospective HIPAA-compliant study. Electronic medical records were reviewed for 102 patients with hyperparathyroidism who underwent triple-phase 4D CT and parathyroid surgery resulting in pathologically proved removal of adenoma from July 2010 through December 2011. Hounsfield units were measured in PTA, thyroid, lymph nodes, and aorta and were used to determine seven parameters characterizing tissue contrast enhancement. These were used as covariates in 10 multinomial logistic regression models. Three models with one covariate, four models with two covariates, and three models with three covariates were investigated. Receiver operating characteristic (ROC) analysis was performed to determine how well each model discriminated between adenoma and nonadenomatous tissues. Statistical differences between the areas under the ROC curves (AUCs) for each model pair were calculated, as well as sensitivity, specificity, accuracy, negative predictive value, and positive predictive value.
  
  
  RESULTS
  A total of 120 lesions were found; 112 (93.3%) lesions were weighed, and mean and median weights were 589 and 335 mg, respectively. The three-covariate models were significantly identical (P > .65), with largest AUC of 0.9913 ± 0.0037 (standard error), accuracy of 96.9%, and sensitivity, specificity, negative predictive value, and positive predictive value of 94.3%, 98.3%, 97.1%, and 96.7%, respectively. The one- and two-covariate models were significantly less accurate (P < .043).
  
  
  CONCLUSIONS
  A three-covariate multinomial logistic model derived from a triple-phase 4D CT scan can accurately provide the probability that tissue is PTA and performs significantly better than models using one or two covariates.
authors.affiliation: From the Departments of Neuroradiology (G.J.H., D.T.G., H.R.K.) and Radiology (E.F.H.), Massachusetts General Hospital, 55 Fruit St, Gray 273a, Boston, MA 02114; and Department of Radiology Physics, Brigham and Women's Hospital, Boston, Mass (L.M.H.).
authors.forename: George J
authors.initials: GJ
authors.lastname: Hunter
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Ginat
authors.forename: Hillary R
authors.initials: HR
authors.lastname: Kelly
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Leena M
authors.initials: LM
authors.lastname: Hamberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging; D016015:Logistic Models; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D016606:Thyroid Nodule / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media