title: Comparison of 4D CT, ultrasonography, and 99mTc sestamibi SPECT/CT in localizing single-gland primary hyperparathyroidism.
abstract: OBJECTIVE
  The present study was designed to evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT).
  
  
  METHODS
  Case series with expertized image review.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  A total of 38 patients were recruited for study, all of whom had undergone focused parathyroidectomy for single-lesion primary HPT between June 2011 and September 2013. In each patient, 3 imaging procedures were performed: cervical ultrasonography (US), 99mTc-sestamibi SPECT/CT (SeS), and 4D CT. Collective imaging data were blindly reviewed and compared.
  
  
  RESULTS
  4D CT outperformed US and SeS in terms of sensitivity (P=.27), specificity (P=.01), positive predictive value (PPV) (P<.01), negative predictive value (NPV) (P=.19), and accuracy (P<.01). In 7.9% (3/38) of patients, 4D CT provided specific anatomic information that was unaffordable by US and SeS. Localization by 4D CT correlated with tissue parathyroid hormone level (P=.02), maximum diameter (P=.01), and volume (P<.01) of abnormal parathyroid glands.
  
  
  CONCLUSIONS
  4D CT proved helpful in localizing target parathyroid glands of primary HPT that were missed by traditional imaging.
authors.affiliation: Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yong Joon
authors.initials: YJ
authors.lastname: Suh
authors.affiliation: Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: June Young
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Su-jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Nuclear Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea.
authors.forename: In Kook
authors.initials: IK
authors.lastname: Chun
authors.affiliation: Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Korea.
authors.forename: Tae Jin
authors.initials: TJ
authors.lastname: Yun
authors.affiliation: Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea kyueunlee@snu.ac.kr.
authors.forename: Kyu Eun
authors.initials: KE
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Korea.
authors.forename: Ji-hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea Department of Nuclear Medicine, Seoul National University Hospital and College of Medicine, Seoul, Korea.
authors.forename: Gi Jeong
authors.initials: GJ
authors.lastname: Cheon
authors.affiliation: Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Yeo-Kyu
authors.initials: YK
authors.lastname: Youn
mesh_terms: D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi
keywords: 4-dimensional computed tomography; 99mTc sestamibi SPECT/CT; minimally invasive surgical procedures; primary hyperparathyroidism; ultrasonography