title: Four-dimensional computed tomography scan utility in parathyroidectomy for primary hyperparathyroidism with low baseline intact parathyroid hormone.
abstract: The prevalence of multiglandular disease (MGD) of the parathyroid has been reported to be higher in patients with primary hyperparathyroidism and low baseline intact parathyroid hormone (PTH) levels (<100 pg/mL). Low baseline PTH is associated with lower localization rate and positive predictive value with both preoperative sestamibi and ultrasound. This study sought to evaluate our experience with four-dimensional computed tomography (4D-CT) for the localization of abnormal parathyroid glands, including MGD, in patients with low baseline intact PTH (LBiPTH).
  
  
  
  A single institution case series.
  
  
  
  A case series of patients with primary hyperparathyroidism with low baseline PTH or an inconclusive sestamibi, who underwent surgery with a single surgeon from April 2012 to June 2015 following 4D-CT to help with abnormal gland localization.
  
  
  
  We identified 14 patients who underwent a 4D-CT in the setting of primary hyperparathyroidism and LBiPTH. A sestamibi scan had been ordered in 71% and was inconclusive in all cases. No ultrasound was performed. In all patients, 4D-CT was 84.6% sensitive in localizing abnormal glands, yielding a positive predictive value of 91.7%. Overall, 42.9% of patients had evidence of MGD, and 4D-CT detected 83.3% of MGD cases. A focused unilateral exploration was performed in 28.6% of cases, and a four-gland exploration was performed in all remaining patients.
  
  
  
  In patients with hypercalcemia and LBiPTH, with higher likelihood of MGD and of inconclusive results on sestamibi, 4D-CT may be a superior modality for localizing smaller adenoma or multiple hypercellular glands. This may allow for improved interpretation of intraoperative PTH results, and in a minority of cases, a focused parathyroid exploration.
  
  
  
  4 Laryngoscope, 127:1476-1482, 2017.
authors: Otolaryngology-Head and Neck Surgery Department, Stanford University, Stanford, California, U.S.A.
authors: Anaïs
authors: A
authors: Rameau
authors: Endocrinology Department, Kaiser Permanente Hospital, Santa Clara, California, U.S.A.
authors: Soo
authors: S
authors: Eng
authors: Endocrinology Department, Kaiser Permanente Hospital, Santa Clara, California, U.S.A.
authors: Joseph
authors: J
authors: Vu
authors: Neuroradiology Division, Kaiser Permanente Hospital, Santa Clara, California, U.S.A.
authors: Ramin
authors: R
authors: Saket
authors: Neuroradiology Division, Kaiser Permanente Hospital, Santa Clara, California, U.S.A.
authors: Peter
authors: P
authors: Jun
authors: Otolaryngology-Head and Neck Surgery Department, Stanford University, Stanford, California, U.S.A.|Department of Otolaryngology-Head and Neck Surgery, Kaiser Permanente Hospital, Santa Clara, California, U.S.A.
authors: Michael
authors: M
authors: Friduss
mesh_terms: D002118:Calcium / Q000097:blood; D005260:Female; D056973:Four-Dimensional Computed Tomography / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000209:etiology / Q000601:surgery; D049950:Hyperparathyroidism, Primary / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000379:methods*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi
chemical_list: D010281:Parathyroid Hormone; D017256:Technetium Tc 99m Sestamibi; D002118:Calcium
keywords: Endocrine; imaging; parathyroid; parathyroid surgery; preoperative workup