title: Diagnostic value and clinical impact of complementary CT scan prior to surgery for non-localized primary hyperparathyroidism.
abstract: BACKGROUND
  Successful localization is mandatory for focused parathyroidectomy. If ultrasound and sestamibi scan are negative, bilateral neck exploration is necessary. We examined the contribution of complementary computed tomography (CT) scan to identify the affected parathyroid gland.
  
  
  METHODS
  Between November 1999 and April 2014, 25 patients (20 females and 5 males; mean age 67 ± 11 years) with negative or dubious standard imaging (ultrasound and sestamibi scan) underwent CT scan prior to parathyroidectomy and were included in this study. Fifteen patients had had previous neck surgery for parathyroidectomy (n = 11) or thyroidectomy (n = 4). Thin-slice CT (n = 9) or four-dimensional (4D) CT imaging (n = 16) was used. Cure was defined as >50 % post-excision fall of intraoperatively measured parathyroid hormone or fall into the normal range, confirmed by normocalcaemia at least 6 months after surgery.
  
  
  RESULTS
  Preoperative CT scan provided correct localization in 13 out of 25 patients (52 %) and was false positive once. Parathyroidectomy was performed by a focused approach in 11 of these 13 patients as well as in 1 patient guided by intraoperatively measured parathyroid hormone (ioPTH). Thirteen patients required bilateral neck exploration. The cure rate was 96 % (24/25 patients). One patient has persistent primary hyperparathyroidism (pHPT) and one a recurrent disease. Six patients presented a multiglandular disease.
  
  
  CONCLUSIONS
  A CT scan identifies about half of abnormal parathyroid glands missed by conventional imaging and allows focused surgery in selected cases.
authors.affiliation: Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Academic Teaching Hospital, University of Duisburg-Essen, Henricistraße 92, 45136, Essen, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Seeliger
authors.forename: P F
authors.initials: PF
authors.lastname: Alesina
authors.forename: J-A
authors.initials: JA
authors.lastname: Koch
authors.forename: J
authors.initials: J
authors.lastname: Hinrichs
authors.forename: B
authors.initials: B
authors.lastname: Meier
authors.forename: M K
authors.initials: MK
authors.lastname: Walz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D016105:Parathyroidectomy / Q000379:methods*; D012086:Reoperation / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol