title: Diagnostic performance of computed tomography for parathyroid adenoma localization; a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic review and meta-analysis of the sensitivity and positive predictive value (PPV) of CT for preoperative parathyroid localization in patients with primary hyperparathyroidism (pHPT), and subsequently compare the different protocols and their performance in different patient groups.
  
  
  METHODS
  We performed a search of the Embase, Pubmed and Cochrane Library databases to identify studies published between January 1, 2000 and March 31, 2016 investigating the diagnostic value of CT for parathyroid localization in patients with biochemical diagnosis of pHPT. Performance of CT was expressed in sensitivity and PPV with pooled proportion using a random-effects model. Factors that could have affected the diagnostic performance were investigated by subgroup analysis.
  
  
  RESULTS
  Thirty-four studies evaluating a total of 2563 patients with non-familial pHPT who underwent CT localization and surgical resection were included. Overall pooled sensitivity of CT for localization of the pathological parathyroid(s) to the correct quadrant was 73% (95% CI: 69-78%), which increased to 81% (95% CI: 75-87%) for lateralization to the correct side. Subgroup analysis based on the number of contrast phases showed that adding a second contrast phase raises sensitivity from 71% (95% CI: 61-80%) to 76% (95% CI: 71-87%), and that adding a third phase resulted in a more modest additional increase in performance with a sensitivity of 80% (95% CI: 74-86%).
  
  
  CONCLUSIONS
  CT performs well in localizing pathological glands in patients with pHPT. A protocol with two contrast phases seems to offer a good balance of acceptable performance with limitation of radiation exposure.
authors.affiliation: Department of Surgery, University of California San Francisco, United States; Department of Surgery, University Medical Center Utrecht, The Netherlands. Electronic address: WPKluijfhout@gmail.com.
authors.forename: Wouter P
authors.initials: WP
authors.lastname: Kluijfhout
authors.affiliation: Department of Surgery, University Health Network Toronto, Canada.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Pasternak
authors.affiliation: Department of Surgery, University of California San Francisco, United States.
authors.forename: Toni
authors.initials: T
authors.lastname: Beninato
authors.affiliation: Department of Surgery, University of California San Francisco, United States.
authors.forename: Frederick Thurston
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Department of Surgery, University of California San Francisco, United States.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Gosnell
authors.affiliation: Department of Surgery, University of California San Francisco, United States.
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.affiliation: Department of Surgery, University of California San Francisco, United States.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, USA.
authors.forename: Isabel E
authors.initials: IE
authors.lastname: Allen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, The Netherlands.
authors.forename: Menno R
authors.initials: MR
authors.lastname: Vriens
authors.affiliation: Department of Radiology, University Medical Center Utrecht, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: de Keizer
authors.affiliation: Department of Radiology, University of California San Francisco, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hope
authors.affiliation: Department of Surgery, University of California San Francisco, United States.
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: CT; Meta-analysis; Parathyroid localization; Primary hyperparathyroidism