title: Adenoma localization for recurrent or persistent primary hyperparathyroidism using dynamic four-dimensional CT and venous sampling.
abstract: OBJECTIVE
  To determine if parathyroid venous sampling (PVS) combined with four-dimensional (4D) computed tomography (CT) improves sensitivity and accuracy of identification of parathyroid adenoma in patients with recurrent or persistent primary hyperparathyroidism (pHPT) and negative technetium-99m methoxyisobutyl isonitrile ((99m)Tc-MIBI) and ultrasound (US) scans.
  
  
  METHODS
  Both PVS and 4D CT were performed in 28 patients with recurrent or persistent pHPT and negative (99m)Tc-MIBI and US examinations. Localization by 4D CT alone and in combination with PVS and lateralization by PVS alone were retrospectively assessed for correlation with surgical results. Suspected adenomas on 4D CT were said to correlate with PVS if venous drainage identified on CT corresponded to sites of elevated parathyroid hormone concentration on PVS. Lesions difficult to identify on 4D CT were lesions < 1 cm in longest dimension. Results of 4D CT were classified as positive, negative, or equivocal.
  
  
  RESULTS
  Surgery was performed in 22 of 28 patients. Surgery identified 23 parathyroid adenomas, 1 carcinoma, and 2 hyperplastic glands in 20 patients. 4D-CT alone localized 11 lesions in 10 patients. PVS helped localize 13 additional lesions in nine more patients and clarified two lesions that were equivocal on 4D CT. Comparing 4D CT alone with 4D CT plus PVS, the sensitivity increased from 50% to 95% (P = .004), and accuracy increased from 55% to 91% (P = .022). PVS lateralization had a sensitivity of 93.3%, positive predictive value of 66.7%, and accuracy of 63.6%.
  
  
  CONCLUSIONS
  PVS significantly improves 4D CT localization of parathyroid adenomas in patients undergoing repeat surgery for pHPT with negative (99m)Tc-MIBI and US.
authors.affiliation: Division of Neurointerventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois. Electronic address: ginsburg.misha@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Ginsburg
authors.affiliation: Division of Neurointerventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Christoforidis
authors.affiliation: Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, Chicago, Illinois.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Zivin
authors.affiliation: Division of Neurointerventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Piotr
authors.initials: P
authors.lastname: Obara
authors.affiliation: Division of Neurointerventional Radiology, Department of Radiology, University of Chicago Medical Center, Chicago, Illinois.
authors.forename: Kristen
authors.initials: K
authors.lastname: Wroblewski
authors.affiliation: Endocrine Surgery Research Program, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
authors.forename: Peter
authors.initials: P
authors.lastname: Angelos
authors.affiliation: Endocrine Surgery Research Program, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
authors.forename: Raymon H
authors.initials: RH
authors.lastname: Grogan
authors.affiliation: Endocrine Surgery Research Program, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois.
authors.forename: Edwin L
authors.initials: EL
authors.lastname: Kaplan
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000000981:diagnostic imaging*; D000368:Aged; D005260:Female; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000097:blood* / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D012008:Recurrence; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi