Journal of Otolaryngology-Head & Neck Surgery | |
3-phase dual-energy CT scan as a feasible salvage imaging modality for the identification of non-localizing parathyroid adenomas: a prospective study | |
Reza Forghani2  Mark Levental1  Veronique Forest3  Alex Mlynarek3  Richard J. Payne3  Michael P. Hier3  Xiaoyang Liu1  Michael Roskies3  | |
[1] Department of Radiology, Jewish General Hospital & McGill University, Montreal, Quebec, Canada;Segal Cancer Centre and Lady Davis Institute for Medical Research, Jewish General Hospital & McGillUniversity, Montreal, Quebec, Canada;Department of Otolaryngology-Head and Neck Surgery, Jewish General Hospital & McGill University, Montreal, Quebec, Canada | |
关键词: Minimally invasive parathyroidectomy; 4DCT; 4D-CT; Dual-energy CT; Computed tomography; Head and neck surgery; Parathyroid adenoma; | |
Others : 1230371 DOI : 10.1186/s40463-015-0098-y |
|
received in 2015-05-28, accepted in 2015-10-19, 发布年份 2015 | |
【 摘 要 】
Objectives
Accurate pre-operative imaging of parathyroid adenomas (PAs) is essential for successful minimally invasive surgery; however, rates of non-localizing PAs can be as high as 18 %. Multiphasic dual-energy CT (DECT) has the potential to increase accuracy of PA detection by enabling creation of paired material maps and spectral tissue characterization. This study prospectively evaluated the utility of 3-phase DECT for PA identification in patients with failed localization via standard imaging.
Methods
Patients with primary hyperparathyroidism and non-localizing PAs underwent a 3 phase post-contrast DECT scan acquired at 25, 55, and 85 s. The scans were prospectively evaluated by two head and neck radiologists. Pre-operative localization was compared to intraoperative localization and final histopathology. A post-hoc DECT spectral density characterization was performed on pathologically-proven PAs.
Results
Out of 29 patients with primary hyperparathyroidism and non-localized PAs, DECT identified candidates in 26. Of the 23 patients who underwent parathyroidectomy, DECT provided precise anatomic localization in 20 patients (PPV = 87.0 %), one with multi-gland disease. The virtual unenhanced images were not found to be useful for diagnosis but successful diagnosis was made without an unenhanced phase regardless. Spectral analysis demonstrated a distinct spectral Hounsfield attenuation curve for PAs compared to lymph nodes on arterial phase images.
Conclusion
3-phase DECT without an unenhanced phase is a feasible salvage imaging modality for previously non-localizing parathyroid adenomas. Optimal interpretation is achieved based on a combination of perfusion characteristics and other morphologic features. Advanced spectral DECT analysis has the potential for further increasing accuracy of PA identification in the future.
【 授权许可】
2015 Roskies et al.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20151106041827614.pdf | 3020KB | download | |
Fig. 5. | 53KB | Image | download |
Fig. 4. | 25KB | Image | download |
Fig. 3. | 17KB | Image | download |
Fig. 2. | 74KB | Image | download |
Fig. 1. | 55KB | Image | download |
【 图 表 】
Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
【 参考文献 】
- [1]Munk RS, Payne RJ, Luria BJ, Hier MP, Black MJ. Preoperative localization in primary hyperparathyroidism. J Otolaryngol Head Neck Surg. 2008; 37(3):347-354.
- [2]Phillips CD, Shatzkes DR. Imaging of the parathyroid glands. Semin Ultrasound CT MR. 2012; 33(2):123-129.
- [3]Rodgers SE, Hunter GJ, Hamberg LM, Schellingerhout D, Doherty DB, Ayers GD et al.. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 2006; 140(6):932-940.
- [4]Patel CN, Salahudeen HM, Lansdown M, Scarsbrook AF. Clinical utility of ultrasound and 99mTc sestamibi SPECT/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism. Clin Radiol. 2010; 65(4):278-287.
- [5]Hunter GJ, Schellingerhout D, Vu TH, Perrier ND, Hamberg LM. Accuracy of four-dimensional CT for the localization of abnormal parathyroid glands in patients with primary hyperparathyroidism. Radiology. 2012; 264(3):789-795.
- [6]Hunter GJ, Ginat DT, Kelly HR, Halpern EF, Hamberg LM. Discriminating parathyroid adenoma from local mimics by using inherent tissue attenuation and vascular information obtained with four-dimensional CT: formulation of a multinomial logistic regression model. Radiology. 2014; 270(1):168-175.
- [7]Kelly HR, Hamberg LM, Hunter GJ. 4D-CT for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism: accuracy and ability to stratify patients by unilateral versus bilateral disease in surgery-naive and re-exploration patients. AJNR Am J Neuroradiol. 2014; 35(1):176-181.
- [8]Hoang JK, Sung WK, Bahl M, Phillips CD. How to perform parathyroid 4D CT: tips and traps for technique and interpretation. Radiology. 2014; 270(1):15-24.
- [9]Mortenson MM, Evans DB, Lee JE, Hunter GJ, Shellingerhout D, Vu T et al.. Parathyroid exploration in the reoperative neck: improved preoperative localization with 4D-computed tomography. J Am Coll Surg. 2008; 206(5):888-895.
- [10]Chazen JL, Gupta A, Dunning A, Phillips CD. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol. 2012; 33(3):429-433.
- [11]Welling RD, Olson JA, Kranz PG, Eastwood JD, Hoang JK. Bilateral retropharyngeal parathyroid hyperplasia detected with 4D multidetector row CT. AJNR Am J Neuroradiol. 2011; 32(5):E80-E82.
- [12]Noureldine SI, Aygun N, Walden MJ, Hassoon A, Gujar SK, Tufano RP. Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: How many phases do we really need? Surgery. 2014; 156(6):1300-1306.
- [13]Forghani R, Levental M, Gupta R, Lam S, Dadfar N, Curtin HD. Different Spectral Hounsfield Unit Curve and High-Energy Virtual Monochromatic Image Characteristics of Squamous Cell Carcinoma Compared with Nonossified Thyroid Cartilage. AJNR Am J Neuroradiol. 2015; 36:1194-1200.
- [14]Johnson T, Fink C, Schönberg SO, Reiser MF. Dual Energy CT in Clinical Practice. Springer, Berlin, Heidelberg; 2011.
- [15]Johnson TR. Dual-energy CT: general principles. AJR Am J Roentgenol. 2012; 199(5 Suppl):S3-S8.
- [16]Pomerantz SR, Kamalian S, Zhang D, Gupta R, Rapalino O, Sahani DV et al.. Virtual monochromatic reconstruction of dual-energy unenhanced head CT at 65–75 keV maximizes image quality compared with conventional polychromatic CT. Radiology. 2013; 266(1):318-325.
- [17]De Cecco CN, Darnell A, Rengo M, Muscogiuri G, Bellini D, Ayuso C et al.. Dual-energy CT: oncologic applications. AJR Am J Roentgenol. 2012; 199(5 Suppl):S98-S105.
- [18]Heye T, Nelson RC, Ho LM, Marin D, Boll DT. Dual-energy CT applications in the abdomen. AJR Am J Roentgenol. 2012; 199(5 Suppl):S64-S70.
- [19]Lu GM, Zhao Y, Zhang LJ, Schoepf UJ. Dual-energy CT of the lung. AJR Am J Roentgenol. 2012; 199(5 Suppl):S40-S53.
- [20]Postma AA, Hofman PA, Stadler AA, van Oostenbrugge RJ, Tijssen MP, Wildberger JE. Dual-energy CT of the brain and intracranial vessels. AJR Am J Roentgenol. 2012; 199(5 Suppl):S26-S33.
- [21]Vliegenthart R, Pelgrim GJ, Ebersberger U, Rowe GW, Oudkerk M, Schoepf UJ. Dual-energy CT of the heart. AJR Am J Roentgenol. 2012; 199(5 Suppl):S54-S63.
- [22]Forghani R. Advanced dual-energy CT for head and neck cancer imaging. Expert review of anticancer therapy. 2015;In press.
- [23]Albrecht MH, Scholtz JE, Kraft J, Bauer RW, Kaup M, Dewes P et al.. Assessment of an Advanced Monoenergetic Reconstruction Technique in Dual-Energy Computed Tomography of Head and Neck Cancer. Eur Radiol. 2015; 25(8):2493-2501.
- [24]Kuno H, Onaya H, Iwata R, Kobayashi T, Fujii S, Hayashi R et al.. Evaluation of cartilage invasion by laryngeal and hypopharyngeal squamous cell carcinoma with dual-energy CT. Radiology. 2012; 265(2):488-496.
- [25]Lam S, Gupta R, Levental M, Yu E, Curtin HD, Forghani R. Optimal Virtual Monochromatic Images for Evaluation of Normal Tissues and Head and Neck Cancer Using Dual-Energy CT. AJNR Am J Neuroradiol. 2015; 36:1518-1524.
- [26]Liu X, Ouyang D, Li H, Zhang R, Lv Y, Yang A et al.. Papillary Thyroid Cancer: Dual-Energy Spectral CT Quantitative Parameters for Preoperative Diagnosis of Metastasis to the Cervical Lymph Nodes. Radiology. 2015; 275(1):167-176.
- [27]Tawfik AM, Kerl JM, Bauer RW, Nour-Eldin NE, Naguib NN, Vogl TJ et al.. Dual-energy CT of head and neck cancer: average weighting of low- and high-voltage acquisitions to improve lesion delineation and image quality-initial clinical experience. Investig Radiol. 2012; 47(5):306-311.
- [28]Tawfik AM, Razek AA, Kerl JM, Nour-Eldin NE, Bauer R, Vogl TJ. Comparison of dual-energy CT-derived iodine content and iodine overlay of normal, inflammatory and metastatic squamous cell carcinoma cervical lymph nodes. Eur Radiol. 2014; 24(3):574-580.
- [29]Gimm O, Juhlin C, Morales O, Persson A. Dual-energy computed tomography localizes ectopic parathyroid adenoma. J Clin Endocrinol Metab. 2010; 95(7):3092-3093.
- [30]Eufrazino C, Veras A, Bandeira F. Epidemiology of Primary Hyperparathyroidism and its Non-classical Manifestations in the City of Recife, Brazil. Clin Med Insights Endocrinol Diabetes. 2013; 6:69-74.
- [31]Akbaba G, Berker D, Isik S, Aydin Y, Ciliz D, Peksoy I et al.. A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: ultrasonography, 99mTc sestamibi, single photon emission computed tomography, and magnetic resonance imaging. J Endocrinol Invest. 2012; 35(4):359-364.
- [32]Lumachi F, Ermani M, Basso S, Zucchetta P, Borsato N, Favia G. Localization of parathyroid tumours in the minimally invasive era: which technique should be chosen? Population-based analysis of 253 patients undergoing parathyroidectomy and factors affecting parathyroid gland detection. Endocr Relat Cancer. 2001; 8(1):63-69.
- [33]Schalin-Jantti C, Ryhanen E, Heiskanen I, Seppanen M, Arola J, Schildt J et al.. Planar scintigraphy with 123I/99mTc-sestamibi, 99mTc-sestamibi SPECT/CT, 11C-methionine PET/CT, or selective venous sampling before reoperation of primary hyperparathyroidism? J. Nucl. Med. 2013; 54(5):739-747.
- [34]Herrmann K, Takei T, Kanegae K, Shiga T, Buck AK, Altomonte J et al.. Clinical value and limitations of [11C]-methionine PET for detection and localization of suspected parathyroid adenomas. Mol Imaging Biol. 2009; 11(5):356-363.
- [35]Bergenfelz AO, Wallin G, Jansson S, Eriksson H, Martensson H, Christiansen P et al.. Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound. Langenbecks Arch Surg. 2011; 396(1):83-90.
- [36]Hoang JK, Reiman RE, Nguyen GB, Januzis N, Chin BB, Lowry C et al.. Lifetime Attributable Risk of Cancer From Radiation Exposure During Parathyroid Imaging: Comparison of 4D CT and Parathyroid Scintigraphy. AJR Am J Roentgenol. 2015; 204(5):W579-W585.
- [37]Perrier ND, Edeiken B, Nunez R, Gayed I, Jimenez C, Busaidy N et al.. A novel nomenclature to classify parathyroid adenomas. World J Surg. 2009; 33(3):412-416.