3-phase dual-energy CT scan as a feasible salvage imaging modality for the identification of non-localizing parathyroid adenomas: a prospective study

Journal of Otolaryngology-Head & Neck Surgery

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.

【 图 表 】

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