Highlights
- •Sensitivity and accuracy of pre-operative localization of parathyroid glands is associated with Ca and PTH levels.
- •DECT had a higher sensitivity and accuracy than CT MIBI and US in all patient subgroups.
- •DECT had a salvage detection rate of 52.3% in patients for whom CT MIBI and US did not localize.
- •DECT can be utilized as a first-line or salvage test when CT-MIBI and US are non-localizing.
Abstract
Background
We aimed to investigate the association of preoperative calcium and parathyroid hormone
(PTH) levels with sensitivity and accuracy of dual energy computed tomography (DECT),
single-photon emission CT with 99mTc-sestamibi (CT-MIBI), and ultrasound (US) for pre-operative localization primary
hyperparathyroid (PHP) patients.
Methods
Patients undergoing parathyroidectomy for PHP at a tertiary care facility who underwent
DECT, CT-MIBI and US between 2012 and 2021 were stratified by preoperative calcium
and PTH levels.
Results
Of 278 patients, those with high calcium and PTH levels had a higher sensitivity and
accuracy with DECT (87.7%, 85.2%) compared to CT-MIBI (82.3%, 79.0%), and US (61.7%,
53.1%). DECT was more sensitive and accurate than other preoperative localization
techniques in subgroups with normal PTH (DECT sensitivity 60.9%, accuracy 52.1%) and
normal calcium levels (41.7%, 33.3%).
Conclusion
Preoperative calcium and PTH were associated with sensitivity and accuracy of pre-operative
localization in PHP. DECT was sensitive and accurate for preoperative localization
compared to other first-line imaging techniques.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 16, 2023
Accepted:
January 15,
2023
Received in revised form:
December 13,
2022
Received:
November 4,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
Crown Copyright © 2023 Published by Elsevier Inc. All rights reserved.
