Article Figures & Data
Figures
- Fig 1.
Surgical classification of parathyroid adenoma locations, anterior view. A, Superior, in proximity to the posterior surface of the thyroid parenchyma. B, Superior, fallen posteriorly into the tracheoesophageal groove and no longer in contact with the posterior surface of the thyroid tissue. C, Superior, fallen posteriorly into the tracheoesophageal groove and no longer in contact with the posterior surface of the thyroid tissue at the inferior pole close to the clavicles. D, Superior or inferior, in the midregion of the posterior surface of the thyroid parenchyma near the junction of the recurrent laryngeal nerve and the inferior thyroidal artery. E, Inferior, in the region inferior to the thyroid gland, lying in the anteroposterior plane of the thyroid and anterior to the trachea. F, Inferior, descended into the thyrothymic ligament or superior thymus and possibly appearing to be “ectopic” or in the mediastinum. G, Intrathyroidal.
- Fig 2.
Patient selection flowchart. Thirty-one patients were included in the final analysis.
- Fig 3.
A, The axial arterial phase of a multiphase multidetector 4D CT image shows a right tracheoesophageal parathyroid adenoma (type C; Fig 1). B, Anterior and posterior delay planar scintigraphy shows retention of the radiotracer on the right side. C, An axial SPECT image shows retention of the radiotracer in the lower neck. D, An axial SPECT image fused to a noncontrast CT image localizes the retention of the radiotracer to the right tracheoesophageal groove. E, An axial SPECT image fused to the axial arterial phase of a multiphase multidetector 4D CT image localizes the retention of the radiotracer with concomitant early enhancement to the right tracheoesophageal groove. Red and white arrows show the parathyroid adenoma.
- Fig 4.
A case in which 4DCT could diagnose a parathyroid adenoma in the face of a sestamibi study with negative findings. A, The axial arterial phase of a multiphase multidetector 4D CT image shows a small early-enhancing left paraesophageal parathyroid adenoma (arrow). B, An axial MIBI SPECT image fused to a noncontrast CT image reveals no retention of the radiotracer in the left central compartment of a surgically proven parathyroid adenoma, which was effectively demonstrated on 4DCT (arrow). C, An axial SPECT image fused to the axial arterial phase of a multiphase multidetector 4D CT image shows a small early-enhancing left paraesophageal parathyroid adenoma (arrow).
Tables
- Table 1:
Diagnostic accuracy of left/right localization of parathyroid adenomas in the 31 patients in our study group
Imaging Modality Left No. (%) Right No. (%) Total No. (%) Accuracy (95% CI) MIBI SPECT 93.5 (78.6–99.2) Left 13 (41.9) 1 (3.2) 14 (45.2) Right 1 (3.2) 16 (51.6) 17 (54.8) 4DCT 96.8 (83.3–99.9) Left 14 (45.2) 1 (3.2) 15 (48.4) Right 0 (0.0) 16 (51.6) 16 (51.6) MIBI SPECT + 4DCT 96.8 (83.3–99.9) Left 14 (45.2) 1 (3.2) 15 (48.4) Right 0 (0.0) 16 (51.6) 16 (51.6) Total 14 (45.2) 17 (54.8) - Table 2:
Diagnostic accuracy of embryologic origin of the abnormal parathyroid gland in the 31 patients in our study group
Imaging Modality Superior No. (%) Inferior No. (%) Total No. (%) Accuracy (95% CI) MIBI SPECT 74.2 (55.4–88.1) Superior gland 10 (32.3) 0 (0) 10 (32.3) Inferior gland 8 (25.8) 13 (41.9) 21 (67.7) Total 18 (58.1) 13 (41.9) 4DCT 90.3 (74.3–98.0) Superior gland 15 (48.4) 0 (0) 15 (48.6) Inferior gland 3 (9.7) 13 (41.9) 16 (51.6) Total 18 (58.1) 13 (41.9) MIBI SPECT + 4DCT 96.8 (83.3–99.9) Superior gland 17 (54.8) 0 (0) 17 (54.8) Inferior gland 1 (3.2) 13 (41.9) 14 (45.2) Total 18 (58.1) 13 (41.9) - Table 3:
Diagnostic accuracy of quadrant localization of parathyroid adenomas in the 31 patients in our study group
Imaging Modality LI No. (%) LS No. (%) RI No. (%) RS No. (%) Total No. (%) Accuracy (95% CI) MIBI SPECT 67.7 (48.6–83.3) LI 2 (6.5) 2 (6.5) 1 (3.2) 0 (0) 5 (16.1) LS 0 (0) 9 (29.0) 0 (0) 0 (0) 9 (29.0) RI 0 (0) 0 (0) 10 (32.3) 6 (19.4) 16 (51.6) RS 0 (0) 1 (3.2) 0 (0) 0 (0) 1 (3.2) 4DCT 87.1 (70.2–96.4) LI 2 (6.5) 1 (3.2) 1 (3.2) 0 (0) 4 (12.9) LS 0 (0) 11 (35.5) 0 (0) 0 (0) 11 (35.5) RI 0 (0) 0 (0) 10 (32.3) 2 (6.5) 12 (38.7) RS 0 (0) 0 (0) 0 (0) 4 (12.9) 4 (12.9) MIBI SPECT + 4DCT 93.5 (78.6–99.2) LI 2 (6.5) 0 (0) 1 (3.2) 0 (0) 3 (9.7) LS 0 (0) 12 (38.7) 0 (0) 0 (0) 12 (38.7) RI 0 (0) 0 (0) 10 (32.3) 1 (3.2) 11 (35.5) RS 0 (0) 0 (0) 0 (0) 5 (16.1) 5 (16.1) Total 2 (6.5) 12 (38.7) 11 (35.5) 6 (19.4) Note:—LI indicates left inferior; LS, left superior; RI, right inferior; RS, right superior.
- Table 4:
Diagnostic accuracy of surgical classification (Fig 1) of parathyroid adenomas in the 31 patients in our study group
Imaging Modality A No. (%) B No. (%) C No. (%) D No. (%) E No. (%) Total No. (%) Accuracy (95% CI) MIBI SPECT 54.8 (36.0–72.7) A 3 (9.7) 1 (3.2) 0 (0) 0 (0) 0 (0) 4 (12.9) B 2 (6.5) 3 (9.7) 0 (0) 0 (0) 0 (0) 5 (16.1) C 2 (6.5) 2 (6.5) 3 (9.7) 1 (3.2) 0 (0) 8 (25.8) D 0 (0) 1 (3.2) 0 (0) 0 (0) 0 (0) 1 (3.2) E 2 (6.5) 2 (6.5) 0 (0) 0 (0) 8 (25.8) 12 (38.7) F 0 (0) 0 (0) 0 (0) 0 (0) 1 (3.2) 1 (3.2) 4DCT 61.3 (42.2–78.2) A 7 (22.6) 4 (12.9) 0 (0) 0 (0) 0 (0) 11 (35.5) B 1 (3.2) 2 (6.5) 0 (0) 0 (0) 0 (0) 3 (9.7) C 0 (0) 1 (3.2) 3 (9.7) 0 (0) 0 (0) 4 (12.9) D 0 (0) 0 (0) 0 (0) 1 (3.2) 3 (9.7) 4 (12.9) E 1 (3.2) 2 (6.5) 0 (0) 0 (0) 6 (19.4) 9 (29.0) F 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) MIBI SPECT + 4DCT 74.2 (55.4–88.1) A 7 (22.6) 3 (9.7) 0 (0) 0 (0) 0 (0) 10 (32.3) B 0 (0) 4 (12.9) 0 (0) 0 (0) 0 (0) 4 (12.9) C 0 (0) 2 (6.5) 3 (9.7) 1 (3.2) 0 (0) 6 (19.4) D 2 (6.5) 0 (0) 0 (0) 0 (0) 0 (0) 2 (6.5) E 0 (0) 0 (0) 0 (0) 0 (0) 9 (29) 9 (29.0) F 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) 0 (0) Total 9 (29) 9 (29) 3 (9.7) 1 (3.2) 9 (29.0) - Table 5:
Level of confidence response from 3 reading groups for lateralization, upper/lower quadrant localization, and localization by surgical classification
Response/Imaging Modality Certain (%) Equivocal (%) Uncertain (%) Lateralization MIBI SPECT 27 (87.1) 1 (3.2) 3 (9.7) 4DCT 30 (96.8) 1 (3.2) 0 (0.0) MIBI SPECT + 4DCT 29 (93.5) 2 (6.5) 0 (0.0) Upper/lower MIBI SPECT 22 (71.0) 6 (19.4) 3 (9.7) 4DCT 30 (96.8) 1 (3.2) 0 (0.0) MIBI SPECT + 4DCT 31 (100.0) 0 (0.0) 0 (0.0) Surgical localization MIBI SPECT 15 (48.4) 15 (48.4) 1 (3.2) 4DCT 28 (90.3) 3 (9.7) 0 (0.0) MIBI SPECT + 4DCT 29 (93.5) 1 (3.2) 1 (3.2) - Table 6:
McNemar test of paired imaging modalities for diagnostic accuracy of left/right localization of parathyroid adenomas in the 31 patients in our study group
Imaging Modality Correct Wrong Total P Value 4DCT vs MIBI SPECT Correct 28 1 29 .56 Wrong 2 0 2 Total 30 1 31 MIBI SPECT + 4DCT vs 4DCT Correct 29 1 30 1.00 Wrong 1 0 1 Total 30 1 31 MIBI SPECT + 4DCT vs MIBI SPECT Correct 28 1 29 .56 Wrong 2 0 2 Total 30 1 31 - Table 7:
McNemar test of paired imaging modalities for diagnostic accuracy of embryologic origin of the abnormal parathyroid gland in the 31 patients in our study group
Imaging Modality Correct Wrong Total P Value 4DCT vs MIBI SPECT Correct 22 1 23 .06 Wrong 6 2 8 Total 28 3 31 MIBI SPECT + 4DCT vs 4DCT Correct 28 0 28 .16 Wrong 2 1 3 Total 30 1 31 MIBI SPECT + 4DCT vs MIBI SPECT Correct 23 0 23 .008 Wrong 7 1 8 Total 30 1 31 - Table 8:
McNemar test of paired imaging modalities for diagnostic accuracy of quadrant localization of the abnormal parathyroid gland in the 31 patients in our study group
Imaging Modality Correct Wrong Total P Value 4DCT vs MIBI SPECT Correct 19 2 21 .06 Wrong 8 2 10 Total 27 4 31 MIBI SPECT + 4DCT vs 4DCT Correct 26 1 27 .32 Wrong 3 1 4 Total 29 2 31 MIBI SPECT + 4DCT vs MIBI SPECT Correct 20 1 21 .01 Wrong 9 1 10 Total 29 2 31 - Table 9:
McNemar test of paired imaging modalities for diagnostic accuracy of surgical localization of the abnormal parathyroid gland in the 31 patients in our study group
Imaging Modality Correct Wrong Total P Value 4DCT vs MIBI SPECT Correct 11 6 17 .06 Wrong 8 6 14 Total 19 12 31 MIBI SPECT + 4DCT vs 4DCT Correct 16 3 19 0.21 Wrong 7 5 12 Total 23 8 31 MIBI SPECT + 4DCT vs MIBI SPECT Correct 15 2 17 .06 Wrong 8 6 14 Total 23 8 31
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