Performance of magnetic resonance imaging in the evaluation of first-time and reoperative primary hyperparathyroidism.
Preoperative imaging in patients with primary hyperparathyroidism and a previous parathyroid operation is essential; however, performance of conventional imaging is poor in this subgroup. Magnetic resonance imaging appears to be a good alternative, though overall evidence remains scarce. We retrospectively investigated the performance of magnetic resonance imaging in patients with and without a previous parathyroid operation, with a separate comparison for dynamic gadolinium-enhanced magnetic resonance imaging.



All patients undergoing magnetic resonance imaging prior to parathyroidectomy for primary hyperparathyroidism (first time or recurrent) between January 2000 and August 2015 at a high-volume, tertiary care, referral center for endocrine operations were included. We compared the sensitivity and positive predictive value of magnetic resonance imaging with conventional ultrasound and sestamibi on a per-lesion level.



A total of 3,450 patients underwent parathyroidectomy, of which 84 patients with recurrent (n = 10) or persistent (n = 74) disease and 41 patients with a primary operation were included. Magnetic resonance imaging had a sensitivity and positive predictive value of 79.9% and 84.7%, respectively, and performance was good in both patients with and without a previous parathyroid operation. Adding magnetic resonance imaging to the combination of ultrasound and sestamibi resulted in a significant increase in sensitivity from 75.2% to 91.5%. Dynamic magnetic resonance imaging produced excellent results in the reoperative group, with sensitivity and a positive predictive value of 90.1%.



Technologic advances have enabled faster and more accurate magnetic resonance imaging protocols, making magnetic resonance imaging an excellent alternative modality without associated ionizing radiation. Our study shows that the sensitivity of multimodality imaging for parathyroid adenomas improved significantly with the use of conventional and dynamic magnetic resonance imaging, even in the case of recurrent or persistent disease.
Department of Surgery, University of California, San Francisco, CA; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Wouter P
WP
Kluijfhout
Department of Surgery, University of California, San Francisco, CA.
Shriya
S
Venkatesh
Department of Surgery, University of California, San Francisco, CA.
Toni
T
Beninato
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Menno R
MR
Vriens
Department of Surgery, University of California, San Francisco, CA.
Quan-Yang
QY
Duh
Department of Radiology, University of California, San Francisco, CA.
David M
DM
Wilson
Department of Radiology, University of California, San Francisco, CA.
Thomas A
TA
Hope
Department of Surgery, University of California, San Francisco, CA. Electronic address: Insoo.Suh@ucsf.edu.
Insoo
I
Suh
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy; D011237:Predictive Value of Tests; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult
D003287:Contrast Media; D019786:Gadolinium DTPA