| 1. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet 2018;391:168-78. |
Review/Other-Dx |
N/A |
To discuss hyperparathyroidism |
No results stated in the abstract. |
4 |
| 2. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 151(10):959-968, 2016 10 01. |
Review/Other-Dx |
N/A |
To develop evidence-based guidelines to enhance the appropriate, safe, and effective practice of parathyroidectomy. |
Initial evaluation should include 25-hydroxyvitamin D measurement, 24-hour urine calcium measurement, dual-energy x-ray absorptiometry, and supplementation for vitamin D deficiency. Parathyroidectomy is indicated for all symptomatic patients, should be considered for most asymptomatic patients, and is more cost-effective than observation or pharmacologic therapy. Cervical ultrasonography or other high-resolution imaging is recommended for operative planning. Patients with nonlocalizing imaging remain surgical candidates. Preoperative parathyroid biopsy should be avoided. Surgeons who perform a high volume of operations have better outcomes. The possibility of multigland disease should be routinely considered. Both focused, image-guided surgery (minimally invasive parathyroidectomy) and bilateral exploration are appropriate operations that achieve high cure rates. For minimally invasive parathyroidectomy, intraoperative parathyroid hormone monitoring via a reliable protocol is recommended. Minimally invasive parathyroidectomy is not routinely recommended for known or suspected multigland disease. Ex vivo aspiration of resected parathyroid tissue may be used to confirm parathyroid tissue intraoperatively. Clinically relevant thyroid disease should be assessed preoperatively and managed during parathyroidectomy. Devascularized normal parathyroid tissue should be autotransplanted. Patients should be observed postoperatively for hematoma, evaluated for hypocalcemia and symptoms of hypocalcemia, and followed up to assess for cure defined as eucalcemia at more than 6 months. Calcium supplementation may be indicated postoperatively. Familial pHPT, reoperative parathyroidectomy, and parathyroid carcinoma are challenging entities that require special consideration and expertise. |
4 |
| 3. Yeh MW, Ituarte PH, Zhou HC, et al. Incidence and prevalence of primary hyperparathyroidism in a racially mixed population. J Clin Endocrinol Metab 2013;98:1122-9. |
Observational-Dx |
15,234 patients |
To examine the incidence and prevalence of primary hyperparathyroidism (PHPT) within a racially mixed population. |
Initial case finding identified 15,234 patients with chronic hypercalcemia, 13,327 (87%) of which had PHPT as defined by elevated or inappropriately normal parathyroid hormone levels. The incidence of PHPT fluctuated from 34 to 120 per 100,000 person-years (mean 66) among women, and from 13 to 36 (mean 25) among men. With advancing age, incidence increased and sex differences became pronounced (incidence 12-24 per 100,000 for both sexes younger than 50 y; 80 and 36 per 100,000 for women and men aged 50-59 y, respectively; and 196 and 95 for women and men aged 70-79 y, respectively). The incidence of PHPT was highest among blacks (92 women; 46 men, P < .0001), followed by whites (81 women; 29 men), with rates for Asians (52 women, 28 men), Hispanics (49 women, 17 men), and other races (25 women, 6 men) being lower than that for whites (P < .0001). The prevalence of PHPT tripled during the study period, increasing from 76 to 233 per 100,000 women and from 30 to 85 per 100 000 men. Racial differences in prevalence mirrored those found in incidence. |
2 |
| 4. Gracie D, Hussain SS. Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review. [Review]. J Laryngol Otol. 126(3):221-7, 2012 Mar. |
Review/Other-Dx |
N/A |
To reviews the evidence for these methods to determine: (1) whether these new, minimally invasive techniques are comparable to conventional bilateral neck exploration methods in terms of success and complication rate; and (2) if they are comparable, which technique is likely to be best for cosmesis, patient safety and patient satisfaction. |
This paper recommends that the treatment of choice for solitary adenoma (in most healthcare centres) should be open minimal incision parathyroidectomy, due to advantages in operative duration, learning curve and cost-effectiveness. |
4 |
| 5. Kunstman JW, Udelsman R. Superiority of minimally invasive parathyroidectomy. [Review]. Adv Surg. 46:171-89, 2012. |
Observational-Dx |
N/A |
To discuss the superiority of minimally Invasive Parathyroidectomy. |
No results stated in the abstract |
4 |
| 6. Laird AM, Libutti SK. Minimally Invasive Parathyroidectomy Versus Bilateral Neck Exploration for Primary Hyperparathyroidism. [Review]. Surg Oncol Clin N Am. 25(1):103-18, 2016 Jan. |
Review/Other-Dx |
N/A |
To discuss the advantages of Minimally Invasive Parathyroidectomy(MIP) versus Bilateral Neck Exploration(BNE) for Primary Hyperparathyroidism. |
No results sated in the abstract |
4 |
| 7. Mancilla EE, Levine MA, Adzick NS. Outcomes of minimally invasive parathyroidectomy in pediatric patients with primary hyperparathyroidism owing to parathyroid adenoma: A single institution experience. J Pediatr Surg. 52(1):188-191, 2017 Jan. |
Review/Other-Dx |
17 patients |
To determine effectiveness of preoperative imaging and MIP aided by intraoperative PTH (ioPTH) measurement in children with primary hyperparathyroidism (PHPT). |
Data were available for 16 of 17 patients age 8-17years (11 females, 6 males): 2 had ectopic intrathymic adenomas while 14 had eutopic adenomas. Fifteen patients had ioPTH, including 14 who underwent MIP, defined as a 2cm central neck incision. All patients with data at 6months postparathyroidectomy (13/16) showed normal PTH and calcium. Ultrasound and sestamibi scans had a combined sensitivity of 87.5%. |
4 |
| 8. Zafereo M, Yu J, Angelos P, et al. American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism. [Review]. Head Neck. 41(7):2398-2409, 2019 Jul. |
Review/Other-Dx |
N/A |
To review the current literature for preoperative parathyroid localization imaging, with discussion of efficacy, cost, and overall value. |
We recommend that planar sestamibi imaging, single photon emission computed tomography (SPECT), SPECT/CT, CT neck/mediastinum with contrast, MRI, and four dimensional CT (4D-CT) may be used in conjunction with high-resolution neck ultrasound to preoperatively localize pathologic parathyroid glands. PubMed literature on parathyroid imaging was reviewed through February 1, 2019. |
4 |
| 9. Joliat GR, Demartines N, Portmann L, Boubaker A, Matter M. Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels. Langenbecks Arch Surg. 400(8):937-44, 2015 Dec. |
Observational-Dx |
197 Patients |
To assess the surgery success in relation to these two parameters. |
There were 197 PHP operations during the study period: 118 MIP and 79 bilateral neck explorations (BNEs). The MIP success rate was 95 % (112/118) with a preoperative MIBI scan?±?CT accurate in 94 % (111/118) of the patients and with correct iPTH in 90 % (106/118) of the cases. Among the 12 iPTH levels that did not meet the confirmation criteria, 10 returned to normal range by postoperative day 2. Treatment failure appeared in three patients (one BNE, two MIPs). |
3 |
| 10. Stack BC Jr, Tolley NS, Bartel TB, et al. AHNS Series: Do you know your guidelines? Optimizing outcomes in reoperative parathyroid surgery: Definitive multidisciplinary joint consensus guidelines of the American Head and Neck Society and the British Association of Endocrine and Thyroid Surgeons. Head Neck. 40(8):1617-1629, 2018 08. |
Review/Other-Dx |
N/A |
To discuss the Optimizing outcomes in reoperative parathyroid surgery |
No results stated in the abstract |
4 |
| 11. Fraser WD. Hyperparathyroidism. Lancet 2009;374:145-58. |
Review/Other-Dx |
N/A |
To discuss the role of Hyperparathyroidism. |
No results stated in the abstract. |
4 |
| 12. Vulpio C, Bossola M, De Gaetano A, et al. Usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. Head Neck. 32(9):1226-35, 2010 Sep. |
Observational-Dx |
21 patients |
To discuss the usefulness of the combination of ultrasonography and 99mTc-sestamibi scintigraphy in the preoperative evaluation of uremic secondary hyperparathyroidism. |
The sensitivities of scintigraphy and ultrasonography were 62% and 55%, and the specificity was 95% for both procedures. The sensitivity of combined techniques was 73%. The scintigraphy detected 7/9 (78%) ectopic PTGs, whereas ultrasonography was always negative. A PTG maximum longitudinal diameter <8 mm, the presence of diffuse hyperplasia, the upper localization of glands, and the presence of concomitant thyroid disease reduced the sensitivity and specificity of imaging techniques. In cases of positive imaging, the rate of intraoperative frozen sections was significantly lower. |
2 |
| 13. Andrade JS, Mangussi-Gomes JP, Rocha LA, et al. Localization of ectopic and supernumerary parathyroid glands in patients with secondary and tertiary hyperparathyroidism: surgical description and correlation with preoperative ultrasonography and Tc99m-Sestamibi scintigraphy. Rev Bras Otorrinolaringol (Engl Ed). 80(1):29-34, 2014 Jan-Feb. |
Observational-Dx |
166 patients |
To define the locations of ectopic and supernumerary PT in patients with renal hyperparathyroidism and to correlate intraoperative findings with preoperative tests. |
In the 166 patients studied, 664 PT were found. Five-hundred-seventy-seven (86.4%) glands were classified as eutopic and 91(13.6%) as ectopic. Eight supernumerary PT were found. The most common sites of ectopic PT were in the retroesophageal and thymic regions. Taken together, USG and MIBI did not identify 56 (61.5%) ectopic glands. MIBI was positive for 69,7% of all ectopic glands located in the mediastinal and thymic regions. |
2 |
| 14. Alkhalili E, Tasci Y, Aksoy E, et al. The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism. World J Surg. 39(3):701-5, 2015 Mar. |
Observational-Dx |
103 Patients |
To evaluate the utility of surgeon-performed neck ultrasound (US) as well as sestamibi scans in the localization of parathyroid glands in patients with SHPT/THPT. |
One hundred and three patients underwent parathyroidectomy for SHPT/THPT. All patients underwent surgeon-performed neck US, while 92 (89%) underwent sestamibi scans. US failed to localize any of the parathyroids in 4 patients (3.8%), while sestamibi was negative in 11 (12%). Forty-seven ectopic glands were identified in 38 patients in whom sestamibi was performed. In five patients (13%), ectopic glands were identified by both modalities, by US only in 6 (16%), by sestamibi only in 8 (21%), and by neither study in 19 patients (50%). US showed new thyroid nodules in 19 patients (18.4 %), leading to lobectomy or thyroidectomy at the time of parathyroidectomy in 16 patients (15.5%). Pathology showed malignancy in 7 patients (6.8%). |
3 |
| 15. Hindie E, Ugur O, Fuster D, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 36(7):1201-16, 2009 Jul. |
Review/Other-Dx |
N/A |
To discuss imaging of primary hyperparathyroidism. |
No results state din the abstract. |
4 |
| 16. Christakis I, Vu T, Chuang HH, et al. The diagnostic accuracy of neck ultrasound, 4D-Computed tomographyand sestamibi imaging in parathyroid carcinoma. Eur J Radiol. 95:82-88, 2017 Oct. |
Observational-Dx |
20 patients |
To investigate the accuracy of available imaging modalities for parathyroid carcinoma (PC) in our institution and to identify which imaging modality, or combination thereof, is optimal in preoperative determination of precise tumor location. |
20 patients fulfilled the inclusion criteria and were analysed. There were 18 US, 18 CT and 9 MIBI scans. The sensitivity and accuracy for tumor localisation of US was 80% (CI 56-94%) and 73% respectively, of 4DCT was 79% (CI 58-93%) and 82%, and of MIBI was 81% (CI 54-96%) and 78%. The sensitivity and accuracy of the combination of CT and MIBI was 94% (CI 73-100%) and 95% and for the combination of US, CT and MIBI was 100% (CI 72-100%) and 100% respectively. The wash-out of the PC lesions, expressed as a percentage change in Hounsfield Units from the arterial phase to early delayed phase was -9.29% and to the late delayed phase was -16.88% (n=11). |
2 |
| 17. Frank E, Ale-Salvo D, Park J, Liu Y, Simental A Jr, Inman JC. Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: A systematic review. Head Neck. 40(7):1577-1587, 2018 07. |
Review/Other-Dx |
28 studies |
To identify the ideal imaging methodology for patients with multigland disease. |
Twenty-eight studies, 13 prospective and 15 retrospective, met inclusion criteria. Nine modalities were evaluated, including: cervical ultrasound (n?=?18), dual-phase 99m Tc-sestamibi (n?=?14), subtraction scintigraphy (n?=?11), combined ultrasound and scintigraphy (n?=?8), single photon emission CT (SPECT; n?=?5), SPECT-CT (n?=?4), contrast-enhanced ultrasound (n?=?1), CT (n?=?1), and MRI (n?=?1). |
4 |
| 18. Kedarisetty S, Fundakowski C, Ramakrishnan K, Dadparvar S. Clinical Value of Tc99m-MIBI SPECT/CT Versus 4D-CT or US in Management of Patients With Hyperparathyroidism. Ear Nose Throat J. 98(3):149-157, 2019 Mar. |
Review/Other-Dx |
58 Patients |
To compare a single-photon emission computed tomography/computed tomography (SPECT/CT), 4D-CT, and US studies in detection of adenomas prior to surgery. |
A total of 58 patients (45 female, 13 male) underwent surgery for parathyroid adenoma. Patients aged 28 to 80 years (mean: 58.8) with parathyroid hormone levels ranging from 42 to 424 pg/mL (mean: 168). All patients underwent preoperative SPECT/CT with 20 mCi technetium-99m MIBI (99mTc-MIBI). Fifty-three patients had additional US imaging and 14 patients had 4D-CT scans. Additionally, 34 patients had injection of 20 mCi 99mTc-MIBI on the day of surgery. Pathological correlation was performed. Comparing SPECT/CT versus 4D-CT resulted in sensitivity (77% vs 80%), specificity (71% vs 75%), and accuracy (77% vs 79%). Ultrasound was less sensitive with similar specificity (44%, 86%, respectively). Combination of SPECT/CT and 4D-CT increased sensitivity to 88%, specificity to 100%, and accuracy to 89%. Combining SPECT/CT with US resulted in sensitivity of 85%, specificity of 83%, and accuracy of 85%. Intraoperative localization substantially improved in patients who received preoperative injections. The SPECT/CT remains the best imaging modality for preoperative localization of parathyroid adenomas with high sensitivity. Combining SPECT/CT with US resulted in increased sensitivity and accuracy. For suspicion of ectopic cases or suspicion of unidentifiable adenoma with negative scintigraphy, addition of 4D-CT is recommended. Intraoperative localization and adjunctive imaging may improve surgical management of patients with hyperparathyroidism. |
4 |
| 19. Kutler DI, Moquete R, Kazam E, Kuhel WI. Parathyroid localization with modified 4D-computed tomography and ultrasonography for patients with primary hyperparathyroidism. Laryngoscope. 121(6):1219-24, 2011 Jun. |
Review/Other-Dx |
N/A |
To report our decade-long experience in using modified 4D-computed tomography in combination with ultrasonography (Mod 4D-CT/US) to localize abnormal parathyroid glands in patients with primary hyperparathyroidism. |
Mod 4D-CT/US demonstrated 94% sensitivity and 96% specificity when these imaging studies were used to lateralize the hyperfunctioning parathyroid glands to one side of the neck. In regard to localizing abnormal parathyroid glands to a specific quadrant of the neck (i.e., right-left; superior-inferior), the sensitivity and specificity of Mod 4D-CT/US was 82% and 93%, respectively. Mod 4D-CT/US had a 92% positive predictive value for single-gland disease and 75% for multigland disease. The negative predictive value for single and multigland disease (MGD) were 73% and 92%, respectively. |
4 |
| 20. 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. 65(4):278-87, 2010 Apr. |
Review/Other-Dx |
63 patients |
To evaluate the accuracy of ultrasound and parathyroid scintigraphy using single photon-emission computed tomography/computed tomography (SPECT/CT) for the preoperative localization of solitary parathyroid adenomas in patients with primary hyperparathyroidism who would be suitable for minimally invasive parathyroid surgery. |
Fifty-nine patients had solitary parathyroid adenomas, three patients had multiglandular hyperplasia, and one patient had multiple parathyroid adenomas confirmed at surgery and histology. Thirty-five solitary parathyroid adenomas were identified preoperatively with ultrasound (64%) and 53 with SPECT-CT (90%). Concordant ultrasound and SPECT/CT findings were found in 35 cases (59%). An additional three adenomas were found with ultrasound alone and 18 adenomas with SPECT/CT alone. Fifty-one of the 56 adenomas localized using combined ultrasound and SPECT/CT were found at the expected sites during surgery. Combined ultrasound and SPECT/CT has an overall sensitivity of 95% and accuracy of 91% for the preoperative localization of solitary parathyroid adenomas. |
4 |
| 21. Scattergood S, Marsden M, Kyrimi E, Ishii H, Doddi S, Sinha P. Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism. Ann R Coll Surg Engl. 101(2):97-102, 2019 Feb. |
Observational-Dx |
184 patients |
To determine the most accurate preoperative localisation technique in primary hyperparathyroidism in a district general hospital setting. |
One hundred and eighty-four patients met the inclusion criteria, of whom 81.5% had a histological diagnosis of a parathyroid adenoma. Ultrasound had higher sensitivity than sestamibi scintigraphy. Used together, ultrasound and sestamibi scintigraphy performed better than either ultrasound or sestamibi scintigraphy alone (P< 0.001). Twenty-two of 184 cases had no lesion located by either ultrasound or sestamibi scintigraphy preoperatively. Where neither ultrasound nor sestamibi scintigraphy located the lesion, additional computed tomography led to the excision of parathyroid pathology in one in ten patients. |
2 |
| 22. Tee MC, Chan SK, Nguyen V, et al. Incremental value and clinical impact of neck sonography for primary hyperparathyroidism: a risk-adjusted analysis. Can J Surg. 56(5):325-31, 2013 Oct. |
Observational-Dx |
208 patients |
To determine the incremental value of adding neck ultrasonography to scintigraphy-based imaging tests. |
Our study included 208 patients. Group II had 0.45 times the odds of BNE versus UNE compared with group I (unadjusted odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25-0.81, p = 0.008). When adjusting for patient age, sex, preoperative calcium level, use of intraoperative PTH monitoring, preoperative PTH level, adenoma size, and number of abnormal parathyroid glands, Group II had 0.48 times the odds of BNE versus UNE compared with group I (adjusted OR 0.48, 95% CI 0.23-1.03, p = 0.06). In a subgroup analysis, only the addition of ultrasonography to SPECT decreased the risk of undergoing BNE compared with SPECT alone (unadjusted OR 0.40, 95% CI 0.19-0.84, p = 0.015; adjusted OR 0.38, 95% CI 0.15-0.96, p = 0.043). |
2 |
| 23. Touska P, Elstob A, Rao N, Parthipun A. SPECT/CT-Guided Ultrasound for Parathyroid Adenoma Localization: A 1-Stop Approach. J Nucl Med Technol. 47(1):64-69, 2019 Mar. |
Review/Other-Dx |
146 patients |
To evaluate the accuracy of 1-stop (single patient-attendance) SPECT/CT-guided ultrasound in the localization of parathyroid adenomata. |
The study included 146 patients (88% single gland, 7% multigland, and 5% negative explorations). The sensitivity and specificity of SPECT/CT-guided ultrasound were 83% and 96%, respectively. The sensitivity was higher for single gland (87%) than multigland disease (70%). The addition of ultrasound significantly increased the sensitivity of the technique (P < 0.001). The presence of concurrent thyroid disease (nodules/thyroiditis) did not adversely affect sensitivity (85% confidence interval, 74.2%-93.1%) compared with normal or atrophic glands (82% confidence interval, 72.3%-89.7%). |
4 |
| 24. Kuzminski SJ, Sosa JA, Hoang JK. Update in Parathyroid Imaging. [Review]. Magn Reson Imaging Clin N Am. 26(1):151-166, 2018 Feb. |
Review/Other-Dx |
N/A |
To provide a background regarding PHPT and key anatomy, and discusses these alternative parathyroid imaging modalities with updates. |
This review provides a background regarding PHPT and key anatomy, and discusses these alternative parathyroid imaging modalities with updates. |
4 |
| 25. Sandqvist P, Nilsson IL, Gryback P, Sanchez-Crespo A, Sundin A. Multiphase Iodine Contrast-Enhanced SPECT/CT Outperforms Nonenhanced SPECT/CT for Preoperative Localization of Small Parathyroid Adenomas. Clin Nucl Med 2019. |
Observational-Dx |
192 patients |
To assess the value of intravenously contrast-enhanced CT in conjunction with Tc-MIBI SPECT for preoperative localization of parathyroid adenoma. |
The median adenoma weight was 330 mg. The addition of contrast-enhanced CT increased the sensitivity from 81.1% to 89.9% (P = 0.003). The specificity of nonenhanced SPECT/CT was similar to contrast-enhanced CT (96.1% vs 97.9%; P = 0.077). For patients with uniglandular disease (n = 140, 94.0%), the sensitivity increased from 86.4% to 93.6% (P = 0.021) and the specificity from 96.2% to 97.9% (P = 0.118) by adding contrast-enhanced CT. In patients with multiglandular disease (n = 9, 6.0%), adding contrast-enhanced CT improved detection sensitivity from 42.1% to 63.2%. However, these patients were few and significance was not reached (P = 0.125). |
2 |
| 26. Rodgers SE, Hunter GJ, Hamberg LM, et al. Improved preoperative planning for directed parathyroidectomy with 4-dimensional computed tomography. Surgery. 140(6):932-40; discussion 940-1, 2006 Dec. |
Observational-Dx |
75 patients |
To compare 4D-CT with sestamibi imaging and ultrasonography as methods for the accurate preoperative localization of hyperfunctioning parathyroid glands before parathyroidectomy. |
4D-CT demonstrated improved sensitivity (88%) over sestamibi imaging (65%) and ultrasonography (57%), when the imaging studies were used to localize (lateralize) hyperfunctioning parathyroid glands to 1 side of the neck. Moreover, when used to localize parathyroid tumors to the correct quadrant of the neck (ie, right inferior, right superior, left inferior, or left superior), the sensitivity of 4D-CT (70%) was significantly higher than sestamibi imaging (33%) and ultrasonography (29%). |
2 |
| 27. Campbell MJ, Sicuro P, Alseidi A, Blackmore CC, Ryan JA Jr. Two-phase (low-dose) computed tomography is as effective as 4D-CT for identifying enlarged parathyroid glands. Int J Surg. 14:80-4, 2015 Feb. |
Observational-Dx |
54 patients |
To hypothesize that a simpler two-phase CT protocol would have a similar sensitivity, specificity and accuracy to those published for 4D-CT, while exposing the patient to less radiation. |
The mean radiation dose of two-phase CT over the course of the study was 5.2 mSv (range 3.5 mSv-9.1 mSv). Two-phase CT had a 77% (CI = 65%-86%) sensitivity and an 87% (CI = 73%-95%) specificity to lateralize enlarged parathyroid glands to the correct side of the neck and a 58% (CI = 45%-68%) sensitivity and 91% (CI = 83%-94%) specificity to localize parathyroid tumors to the correct quadrant of the neck. The overall accuracy of two-phase CT to lateralize enlarged parathyroids was 81% (CI = 73%, 88%) and the accuracy to localize enlarged parathyroids was 79% (CI = 73%, 84%). |
1 |
| 28. 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. 270(1):168-75, 2014 Jan. |
Review/Other-Dx |
102 patients |
To identify a set of parameters, which are based on tissue enhancement and native iodine content obtained from a standardized triple-phase four-dimensional (4D) computed tomographic (CT) scan, that define a multinomial logistic regression model that discriminates between parathyroid adenoma (PTA) and thyroid nodules or lymph nodes. |
A total of 120 lesions were found; 112 (93.3%) lesions were weighed, and mean and median weights were 589 and 335 mg, respectively. The three-covariate models were significantly identical (P > .65), with largest AUC of 0.9913 ± 0.0037 (standard error), accuracy of 96.9%, and sensitivity, specificity, negative predictive value, and positive predictive value of 94.3%, 98.3%, 97.1%, and 96.7%, respectively. The one- and two-covariate models were significantly less accurate (P < .043). |
4 |
| 29. 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. 35(1):176-81, 2014 Jan. |
Observational-Dx |
208 patients |
To evaluate the accuracy of 4D-CT for localization and lateralization of abnormal parathyroid glands in preoperative planning for minimally invasive parathyroidectomy vs bilateral neck exploration at a tertiary referral center. |
Of 208 patients, 155 underwent initial surgery and 53 underwent re-exploration parathyroid surgery. No lesions were found in 8 patients (3.8%). A total of 284 lesions were found in 200 patients; 233 were correctly localized by 4D-CT (82.0%). Of the 200 patients with parathyroid lesions, 146 underwent unilateral and 54 bilateral neck exploration. 4D-CT correctly identified unilateral vs bilateral disease in 179 (89.5%) of 200. 4D-CT correctly localized parathyroid lesions in 126 of the unilateral cases (86.3%). In the re-exploration cohort, 4D-CT correctly identified unilateral vs bilateral disease in 46 (95.8%) of 48. There was no statistically significant difference in subgroups stratified by surgery type (primary or subsequent) and number of scan phases (3 or 4) (P > .56). |
2 |
| 30. Bahl M, Sepahdari AR, Sosa JA, Hoang JK. Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol. Radiology. 277(2):454-62, 2015 Nov. |
Observational-Dx |
94 patients |
To describe the prevalence of three relative enhancement patterns of parathyroid lesions on four-dimensional (4D) computed tomographic (CT) scans. |
Ninety-four patients had 110 parathyroid lesions, including 11 patients with multigland disease. The sensitivity for single-gland disease was 94% (78 of 83) and that for multigland disease was 59% (16 of 27). Type B enhancement was most common, with a prevalence of 57% (54 of 94), followed by type C (22% [21 of 94]) and type A (20% [19 of 94]). Five lesions were interpreted incorrectly as parathyroid adenoma (false-positive), and all lesions had the type C pattern. Relative to the thyroid, lesions categorized as type A by readers had mean attenuation difference (± standard deviation) of 39 HU ± 13 in the arterial phase, and type B lesions had a difference of -58 HU ± 26 in the delayed phase. These values differed from the mean attenuation difference of lesions not in these categories (P < .001). |
2 |
| 31. Bahl M. Preoperative Parathyroid Imaging: Trends in Utilization and Comparative Accuracy of Sonography, Scintigraphy, and 4-Dimensional Computed Tomography. J Comput Assist Tomogr. 43(2):264-268, 2019 Mar/Apr. |
Observational-Dx |
604 patients |
To describe trends in parathyroid imaging utilization and to compare the sensitivities of sonography, scintigraphy, and 4-dimensional computed tomography (4DCT) in different imaging algorithms. |
The study population was composed of 604 patients with 850 adenomas or hyperplastic glands. Sonography was the most common imaging modality, performed in 91.2% (551/604) of patients. The utilization of 4DCT increased in the study period from 1.5% (2/133) in 2009-2010 to 75.8% (72/95) in 2013-2014 (P < 0.01). The overall sensitivities of sonography, scintigraphy, and 4DCT, regardless of order of imaging or imaging algorithm, were 58.6% (456/778), 49.1% (317/645), and 82.3% (121/147), respectively (P < 0.01). |
2 |
| 32. Yeh R, Tay YD, Tabacco G, et al. Diagnostic Performance of 4D CT and Sestamibi SPECT/CT in Localizing Parathyroid Adenomas in Primary Hyperparathyroidism. Radiology. 291(2):469-476, 2019 05. |
Observational-Dx |
400 patients |
To evaluate the diagnostic performance of parathyroid 4D CT and technetium 99m-sestamibi (hereafter, referred to as sestamibi) SPECT/CT in preoperative localization in patients with primary hyperparathyroidism. |
Four hundred patients (319 women, 81 men; mean age, 61 years ± 14 [standard deviation]) were evaluated. Similar diagnostic performance was found in both combined 4D CT with sestamibi SPECT/CT and 4D CT alone (area under the curve [AUC], 0.88 [95% CI: 0.86, 0.90] and 0.87 [95% CI: 0.85, 0.90], respectively; P = .82). Both modalities outperformed sestamibi SPECT/CT (AUC, 0.78; 95% CI: 0.76, 0.81; P < .001). Four-dimensional CT showed higher sensitivity than did sestamibi SPECT/CT (sensitivity, 79.3% [414 of 522] vs 58.0% [303 of 522], respectively; P < .001). In a subset analysis, 4D CT had higher sensitivity than sestamibi SPECT/CT in patients with single-gland disease (sensitivity, 92.5% [297 of 321] vs 75.1% [241 of 321], respectively; P < .001) and with multigland disease (sensitivity, 58.2% [117 of 201] vs 30.8% [62 of 201], respectively; P < .001). |
2 |
| 33. Sho S, Yuen AD, Yeh MW, Livhits MJ, Sepahdari AR. Factors Associated With Discordance Between Preoperative Parathyroid 4-Dimensional Computed Tomographic Scans and Intraoperative Findings During Parathyroidectomy. JAMA Surg. 152(12):1141-1147, 2017 Dec 01. |
Observational-Dx |
411 patients |
To characterize factors associated with missed parathyroid lesions on preoperative 4D-CTs and to investigate patterns of commonly observed errors. |
Of 411 patients studied (mean [SD] age, 59 [14] years; 325 [79.1%] female), 123 (29.9%) had discordance between preoperative 4D-CTs and intraoperative findings. Among the 411 patients, 75 (18.2%) had major discordance, including incorrectly localized adenoma on the contralateral side of the neck, missed double adenoma, and absence of any abnormal lesion detected on 4D-CTs. Compared with concordant cases, discordant cases had higher frequencies of multigland disease (66.7% [82 of 123] vs 24.3% [70 of 288], P?<?.001) and multinodular goiter or thyroid nodule (40.7% [50 of 123] vs 29.2% [84 of 288], P?=?.02). Missed parathyroid lesions were smaller (mean [SD], 0.86 [0.29] vs 1.24 [0.50] cm; P?<?.001) and were more likely to be in the inferior position (65.4% [87 of 133] vs 38.1% [177 of 465], P?<?.001). Parathyroid lesion size of 10 mm or less (odds ratio [OR], 4.37; 95% CI, 2.24-8.54), multigland disease (OR, 7.63; 95% CI, 3.49-16.69), multinodular goiter or thyroid nodule (OR, 1.82; 95% CI, 1.01-3.28), and parathyroid lesion in the inferior position (OR, 6.82; 95% CI, 3.10-14.99) were independently associated with discordant 4D-CT results. |
2 |
| 34. Hoang JK, Williams K, Gaillard F, Dixon A, Sosa JA. Parathyroid 4D-CT: Multi-institutional International Survey of Use and Trends. Otolaryngol Head Neck Surg. 155(6):956-960, 2016 12. |
Observational-Dx |
400 patients |
To perform a survey study to describe the role and trends in the utilization of 4D-CT. Of 361 radiologists, 200 (55%) reported that 4D-CT was used in their practices |
Nineteen (10%) used 4D-CT as the first-line imaging study; 155 (76%) reported that 4D-CT played a secondary role; and 26 (13%) reported that it is performed routinely in combination with ultrasound and scintigraphy. Early adopters of 4D-CT (use for >3 years) were 3 times more likely to use 4D-CT in a first-line role (18%) when compared with radiologists who used 4D-CT for =3 years (6%; P < .05). In conclusion, more than half of radiologists perform 4D-CT, and a majority reported that 4D-CT plays a secondary role. However, this role may change, as utilization is increasing and radiologists may follow early adopters, who are more likely to use it as a first-line study. |
2 |
| 35. Eichhorn-Wharry LI, Carlin AM, Talpos GB. Mild hypercalcemia: an indication to select 4-dimensional computed tomography scan for preoperative localization of parathyroid adenomas. Am J Surg. 201(3):334-8; discussion 338, 2011 Mar. |
Observational-Dx |
135 patients |
To discuss the use use of 4-dimensional computed tomography scan (4D-CT) as an adjunct to sestamibi scanning for preoperative localization. |
Four-dimensional computed tomography scanning was significantly more accurate than sestamibi (73% vs 62%, P = .016). In those with serum calcium levels less than 10.8 mg/dL, 4D-CT scanning was significantly more accurate than sestamibi scanning for the quadrant (45% vs 29%, P = .013) and hemisphere (66% vs 48%, P = .012). Also, 4D-CT scanning was more accurate among patients with parathyroid gland weights less than 500 mg (69% vs 45%, P < .001). |
2 |
| 36. Brown SJ, Lee JC, Christie J, et al. Four-dimensional computed tomography for parathyroid localization: a new imaging modality. ANZ J Surg. 85(6):483-7, 2015 Jun. |
Observational-Dx |
100 patients |
To examine the utility of Four-dimensional computed tomography (4DCT) in defined clinical situations. |
The overall sensitivity of 4DCT was 92% compared with 70% for SeS. The sensitivity of 4DCT was superior to SeS in Groups B and C (76% versus 0% and 91% versus 46%, respectively). The overall cure rate was 98%, with 94% of cases completed as minimally invasive procedures. Up to 62% of Group B cases potentially avoided a bilateral neck exploration owing to a positive 4DCT. |
2 |
| 37. Starker LF, Mahajan A, Bjorklund P, Sze G, Udelsman R, Carling T. 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism. Ann Surg Oncol. 18(6):1723-8, 2011 Jun. |
Observational-Dx |
87 patients |
To discuss the use of 4D parathyroid CT as the initial localization study for patients with de novo primary hyperparathyroidism. |
In this study, 84% of patients (73 of 87) underwent an US, 59.8% (52 of 87) a SeS, and 38.0% (33 of 87) had a 4DCT. 4DCT had improved sensitivity (85.7%) over SeS (40.4%) and US (48.0%) to localize parathyroid tumors to the correct quadrant of the neck (P < 0.005) as well as to localize (lateralize) the parathyroid lesions to one side of the neck (93.9% for 4DCT vs. 71.2% for US and 61.5% for SeS; P < 0.005). 4DCT correctly predicted multiglandular disease (MGD) in 85.7% (6 of 7) patients, whereas US and SeS were unable to detect MGD in any case. All patients achieved cure based on intraoperative parathyroid hormone (PTH) measurements and normalization of intact PTH and S-Ca during follow-up. |
2 |
| 38. Suh YJ, Choi JY, Kim SJ, et al. Comparison of 4D CT, ultrasonography, and 99mTc sestamibi SPECT/CT in localizing single-gland primary hyperparathyroidism. Otolaryngol Head Neck Surg. 152(3):438-43, 2015 Mar. |
Observational-Dx |
38 patients |
To evaluate 4D computerized tomography (CT) as a means of localizing abnormal parathyroid glands in primary hyperparathyroidism (HPT). |
4D CT outperformed US and SeS in terms of sensitivity (P=.27), specificity (P=.01), positive predictive value (PPV) (P<.01), negative predictive value (NPV) (P=.19), and accuracy (P<.01). In 7.9% (3/38) of patients, 4D CT provided specific anatomic information that was unaffordable by US and SeS. Localization by 4D CT correlated with tissue parathyroid hormone level (P=.02), maximum diameter (P=.01), and volume (P<.01) of abnormal parathyroid glands. |
2 |
| 39. Chazen JL, Gupta A, Dunning A, Phillips CD. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol. 33(3):429-33, 2012 Mar. |
Observational-Dx |
35 Patients |
To assess the accuracy of 4D-CT for localizing pathologically proved parathyroid adenomas and hyperplasia found during surgery. |
Of the 35 pathologically proved cases collected over the study period, 32 (sensitivity = 91%) patients were found positive for parathyroid disease using 4D-CT, including 3 cases of multigland disease. For lateralization of single-gland disease, 4D-CT demonstrated an accuracy of 93%. 4D-CT revealed a suboptimal 44% sensitivity, but 100% specificity, for multigland disease. |
2 |
| 40. Tian Y, Tanny ST, Einsiedel P, et al. Four-Dimensional Computed Tomography: Clinical Impact for Patients with Primary Hyperparathyroidism. Ann Surg Oncol. 25(1):117-121, 2018 Jan. |
Observational-Dx |
510 patients |
To assess the added value of 4DCT in our institution in the first 4 years of use. |
A total of 536 parathyroid operations in 510 patients were performed during the study period. The overall cure rate was 99.2% after reoperation in some patients, and the overall sensitivity for SeS was 76.0%, and 74.8% for US. Since 2011, 100 patients without concordant SeS/US findings have undergone 4DCT, with a sensitivity of 72.9%. This is in comparison to the sensitivities for SeS (48.3%) and US (52.3%). 4DCT was more sensitive in patients with persistent/recurrent disease (60.0% compared with SeS 43.8% and US 36.4%) and patients with multigland disease (67.4% compared with SeS 40.9% and US 42.1%). Comparison between outcomes in the pre- versus post-CT era demonstrated no difference in the initial cure rate (95.4 vs. 95.9%, p = 0.85) or the rate of minimally invasive parathyroidectomies (74.5 vs. 79.9%, p = 0.22). |
2 |
| 41. Leiva-Salinas C, Flors L, Durst CR, et al. Detection of parathyroid adenomas using a monophasic dual-energy computed tomography acquisition: diagnostic performance and potential radiation dose reduction. Neuroradiology. 58(11):1135-1141, 2016 Nov. |
Observational-Dx |
60 Patients |
To compare the diagnostic performance of a combination of virtual non-contrast (VNC) images and arterial images obtained from a single-phase dual-energy CT (DECT) acquisition and standard non-contrast and arterial images from a biphasic protocol and to study the potential radiation dose reduction of the former approach. |
Sixty patients (mean age, 65.5 years; age range, 38-87 years) were included in the study. The lateralization and localization accuracy, sensitivity, and positive predicted value (PPV) and negative predicted value (NPV) of the different image datasets were comparable. The combination of VNC and arterial images was more specific than arterial images alone to lateralize a parathyroid lesion (OR = 1.93, p = 0.043). The use of the single-phase protocol resulted in a calculated radiation exposure reduction of 52.8 %. |
2 |
| 42. Linda DD, Ng B, Rebello R, Harish S, Ioannidis G, Young JE. The utility of multidetector computed tomography for detection of parathyroid disease in the setting of primary hyperparathyroidism. Can Assoc Radiol J. 63(2):100-8, 2012 May. |
Observational-Dx |
48 patients |
To evaluate the accuracy of multidetector computed tomography (MDCT) in the detection of parathyroid adenoma and hyperplasia in the setting of primary hyperparathyroidism. |
On pathologic examination, 63 abnormal glands were confirmed in 41 female and 7 male patients (mean age, 63 years). Of the 63 abnormal glands, 40 were adenomatous and 23 were hyperplastic. MDCT demonstrated an 88% (95% confidence interval [CI], 77%-99%) positive predictive value for localizing abnormal hyperfunctioning parathyroid glands. The sensitivity of MDCT in detecting single-gland disease was 80% (95% CI, 68%-92%); whereas the specificity for ruling out hyperfunctioning parathyroid tissue, either adenomatous or hyperplastic, was 75% (95% CI, 51%-99%). The sensitivity for exclusively localizing parathyroid hyperplasia was 17% (95% CI, 2%-33%). The parathyroid adenomas were substantially larger and heavier than their hyperplastic counterparts, with an average weight of 1.51 g (range, 0.08-6.00 g) and 0.42 g (range, 0.02-2.0 g) for adenoma and hyperplasia, respectively. |
1 |
| 43. Silver E, Sadeghi N, Knoll S, Taheri MR. Utility of Single-Phase Computed Tomography in Identifying Parathyroid Adenomas: A Feasibility Study. Curr Probl Diagn Radiol. 47(2):90-93, 2018 Mar - Apr. |
Observational-Dx |
29 patients |
To test the hypothesis that a single-phase neck computed tomography (CT) is not inferior to multiphase neck CT (MPNCT), ultrasound, or nuclear medicine sestamibi scan in identifying parathyroid adenomas (PAs). |
The sensitivity of this method in APNCT is 90.9% whereas positive predictive value is 100%. The sensitivity or positive predictive value of ultrasound and nuclear medicine are 60% or 100% and 90% or 100%, respectively. |
3 |
| 44. Griffith B, Chaudhary H, Mahmood G, et al. Accuracy of 2-Phase Parathyroid CT for the Preoperative Localization of Parathyroid Adenomas in Primary Hyperparathyroidism. AJNR Am J Neuroradiol. 36(12):2373-9, 2015 Dec. |
Observational-Dx |
278 patients |
To assess the feasibility of a protocol using only arterial and venous phases to localize pathologic glands in patients with primary hyperparathyroidism. |
In patients with single-gland disease, the sensitivity and specificity of 2-phase CT to correctly localize the quadrant were 55.4% and 85.9%, respectively. The sensitivity and specificity of correct lateralization were 78.8% and 67.8%, respectively. The sensitivity and specificity to identify multigland disease were 22.9% and 79.5%, respectively. |
1 |
| 45. Krakauer M, Wieslander B, Myschetzky PS, et al. A Prospective Comparative Study of Parathyroid Dual-Phase Scintigraphy, Dual-Isotope Subtraction Scintigraphy, 4D-CT, and Ultrasonography in Primary Hyperparathyroidism. Clin Nucl Med. 41(2):93-100, 2016 Feb. |
Observational-Dx |
97 patients |
To establish the optimal first-line preoperative imaging modality. |
Ninety-seven hyperfunctioning parathyroid glands (HPGs) were identified by the reference standard. Sensitivity and specificity for subtraction PS, dual-phase PS, 4D-CT, and US were 93%, 65%, 58%, and 57% as well as 99%, 99.6%, 86%, and 95%, respectively. Interrater agreement was excellent for subtraction PS (? = 0.96) while only fair for 4D-CT (? = 0.34). Pinhole imaging and subtraction of delayed images (the latter especially in case of a nodular thyroid gland) increased the sensitivity of subtraction PS. SPECT/low-dose CT did not increase sensitivity but aided in the exact localization of the HPGs. Of 7 negative subtraction PS studies, 4D-CT and US were able to locate 3 and 1 additional HPGs, respectively. |
2 |
| 46. Agha A, Hornung M, Rennert J, et al. Contrast-enhanced ultrasonography for localization of pathologic glands in patients with primary hyperparathyroidism. Surgery. 151(4):580-6, 2012 Apr. |
Observational-Dx |
30 patients |
To detect the site of parathyroid lesions using contrast-enhanced ultrasonography (CEUS). |
Using CEUS, all 31 pathologic glands could be detected, compared with 23 using conventional ultrasonography, 25 using (99m)Technetium-sestamibi scintigraphy and 22 using MRI (P = .015). Costs and time requirement were less using CEUS as compared with (99m)Technetium-scintigraphy and MRI examinations (P = .002). Minimally invasive, video-assisted parathyroidectomy could be performed successfully based on CEUS findings in all but 7 patients who required concomitant thyroid surgery or had underwent previous thyroid operations. All patients showed normal serum levels of calcium and parathyroid hormone serum levels 3 months after parathyroidectomy. |
2 |
| 47. Akbaba G, Berker D, Isik S, 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. 35(4):359-64, 2012 Apr. |
Observational-Dx |
82 patients |
To compare the accuracy rates achieved in ultrasonography (US), 99mTc-sestamibi (MIBI), single photon emission computed tomography (SPECT), and magnetic resonance imaging (MRI) as imaging methods used in the pre-operative localization of the enlarged parathyroid glands. |
Pre-operative localization of an abnormal parathyroid gland was successfully performed in 82 of the cases scanned with US (83.7%), while the result was 66 in the cases scanned with MIBI (67.3%), 71 of the cases were successfully localized with SPECT (72.4%), while MRI revealed the diseased gland in only 60 of the total cases (61.2%). In MIBI-positive and -negative patients there was a statistically significant difference among cases in terms of adenoma volume (1.30±1.51 vs 0.58±0.91, p<0.05). Sensitivity, specificity and diagnostic accuracy values were 87.2%, 25.0%, and 83.0%; 70.2%, 50.0%, and 69.4%; 75.5%, 50.0%, and 74.5%; 63.8%, 50.0%, and 63.3% for US, MIBI, SPECT, and MRI, respectively. The respective values for sensitivity, specificity, and diagnostic accuracy were 94.9%, 25.0%, and 91.1% when US was combined with MIBI. |
2 |
| 48. Kluijfhout WP, Venkatesh S, Beninato T, et al. Performance of magnetic resonance imaging in the evaluation of first-time and reoperative primary hyperparathyroidism. Surgery. 160(3):747-54, 2016 09. |
Observational-Dx |
3,450 patients |
To compare the sensitivity and positive predictive value of magnetic resonance imaging with conventional ultrasound and sestamibi on a per-lesion level. |
A total of 3,450 patients underwent parathyroidectomy, of which 84 patients with recurrent (n = 10) or persistent (n = 74) disease and 41 patients with a primary operation were included. Magnetic resonance imaging had a sensitivity and positive predictive value of 79.9% and 84.7%, respectively, and performance was good in both patients with and without a previous parathyroid operation. Adding magnetic resonance imaging to the combination of ultrasound and sestamibi resulted in a significant increase in sensitivity from 75.2% to 91.5%. Dynamic magnetic resonance imaging produced excellent results in the reoperative group, with sensitivity and a positive predictive value of 90.1%. |
2 |
| 49. Grayev AM, Gentry LR, Hartman MJ, Chen H, Perlman SB, Reeder SB. Presurgical localization of parathyroid adenomas with magnetic resonance imaging at 3.0 T: an adjunct method to supplement traditional imaging. Ann Surg Oncol. 19(3):981-9, 2012 Mar. |
Observational-Dx |
25 patients |
To investigate the use of a chemical shift-based water-fat separation magnetic resonance imaging (MRI) method, and time-resolved contrast-enhanced MRI at 3 T for improved presurgical localization of parathyroid adenomas. |
Overall, MRI detected 16 adenomas in 25 patients (sensitivity 64%, positive predictive value 67%), while sestamibi detected 18 of 25 adenomas (sensitivity 72%, positive predictive value 90%). Importantly, MRI was able to detect adenomas in four (57%) of the seven patients whose disease was missed by sestamibi analysis. MRI demonstrated excellent image quality and fat suppression by using a chemical shift-based water-fat separation technique. The time-resolved MRI was considered to be less helpful, although in some cases it was indispensable. |
2 |
| 50. Argiro R, Diacinti D, Sacconi B, et al. Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans. Eur Radiol. 28(11):4900-4908, 2018 Nov. |
Observational-Dx |
57 patients |
To evaluate the diagnostic performance of 3TMRI in comparison with ultrasound (US) and 99mTc-sestamibi scan for presurgical localisation of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT). |
According to surgical findings, US correctly localised 41/46 PTAs (sensitivity of 89.1%; specificity 97.5%; PPV 93.1% and NPV 95.6%); 99mTc-sestamibi correctly localised 38/46 PTAs (sensitivity 83.6%, specificity 98.3%, PPV 95% and NPV 93.7%). US and 99mTc-sestamibi combined had a sensitivity of 93.4% (43/46 PTAs), specificity of 98.3%, PPV 95% and NPV 98.3%. MRI correctly localised 45/46 PTAs (sensitivity 97.8%; specificity 97.5%; PPV 93.7% and NPV 99.2%). MRI was able to detect six adenomas missed by 99mTc-sestamibi and two adenomas missed by US. MRI and US were able to detect all enlarged parathyroid glands in patients with multiglandular disease. MRI identified six of seven ectopic adenomas. |
2 |
| 51. Becker JL, Patel V, Johnson KJ, et al. 4D-Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism. AJNR Am J Neuroradiol 2020;41:522-28. |
Observational-Dx |
54 patients |
To test the hypothesis that our recently introduced 4D-dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation. |
Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease (9 with double-gland hyperplasia; 3 with 3-gland hyperplasia; and 5 with 4-gland hyperplasia). Interobserver agreement (?) for the side (right versus left) was 0.92 for single-gland disease and 0.70 for multigland disease. Interobserver agreement for the quadrant (superior versus inferior) was 0.70 for single-gland disease and 0.69 for multigland disease. For single-gland disease, the gland was correctly located in 34/37 (92%) patients, with correct identification of the side in 37/37 (100%) and the quadrant in 34/37 (92%) patients. For multigland disease, the glands were correctly located in 35/47 (74%) patients, with correct identification of the side in 35/47 (74%) and the quadrant in 36/47 (77%). |
2 |
| 52. Cakal E, Cakir E, Dilli A, et al. Parathyroid adenoma screening efficacies of different imaging tools and factors affecting the success rates. Clin Imaging. 36(6):688-94, 2012 Nov-Dec. |
Observational-Dx |
39 patients |
To compare the efficacy of three different parathyroid adenoma screening tools--high-resolution ultrasonography (USG), technetium Tc 99m-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy, and magnetic resonance imaging (MRI)--and we evaluated the factors affecting the detection success rates. |
Among the 39 patients, USG, parathyroid scintigraphy, and MRI correctly identified 35 adenomas (89.7%), 28 adenomas (71.8%), and 26 adenomas (66.7%), respectively. Positive predictive values for USG (34/35), scintigraphy (27/28), and cervical MR (26/26) imaging were 97.1%, 96%, and 100%, respectively. Parathyroid adenomas were detected with 92.3% (36/39) certainty when both USG and scintigraphy modalities were applied together. Minimally invasive parathyroidectomy under local anesthesia with unilateral incision was successfully performed in 24 (61.5%) patients. |
2 |
| 53. Adkisson CD, Koonce SL, Heckman MG, Thomas CS, Harris AS, Casler JD. Predictors of accuracy in preoperative parathyroid adenoma localization using ultrasound and Tc-99m-Sestamibi: a 4-quadrant analysis. Am J Otolaryngol. 34(5):508-16, 2013 Sep-Oct. |
Observational-Dx |
203 patients |
To compare the accuracy of preoperative parathyroid adenoma localization in patients with primary hyperparathyroidism (pHPT) due to a single adenoma using a detailed 4-quadrant analysis and to identify patient and tumor characteristics associated with accurate preoperative localization. |
Ultrasound was performed on 198 patients, sestamibi on 177 patients, and both on 172 patients. Accurate localization occurred significantly more often for ultrasound than sestamibi (63% vs. 41%, P<0.001). For ultrasound, accurate localization was found in patients with larger or heavier adenomas, those with adenomas located inferiorly, patients not having a reoperative procedure, and patients with higher post-operative serum calcium levels. For sestamibi, greater adenoma size or weight, adenomas located inferiorly, and patients with associated thyroid cancer on pathology were most predictive of accurate preoperative localization. |
2 |
| 54. Caveny SA, Klingensmith WC 3rd, Martin WE, et al. Parathyroid imaging: the importance of dual-radiopharmaceutical simultaneous acquisition with 99mTc-sestamibi and 123I. J Nucl Med Technol. 40(2):104-10, 2012 Jun. |
Observational-Dx |
37 patients |
To compare the accuracy of 3 imaging protocols for the detection of parathyroid adenomas: single-tracer, dual-phase imaging with (99m)Tc-sestamibi; dual-tracer, single-phase imaging with simultaneous acquisition of (99m)Tc-sestamibi and (123)I images; and dual-tracer, dual-phase imaging with simultaneous acquisition of (99m)Tc-sestamibi and (123)I images. |
Thirty-seven patients had 41 parathyroid adenomas. For the 2 observers combined, the localization success rate was 66% for the single-tracer, dual-phase protocol; 94% for the dual-tracer, single-phase protocol; and 90% for the dual-phase, dual-tracer protocol. Both dual-tracer protocols were significantly more accurate than the single-tracer protocol (P < 0.01); there was no significant difference between the 2 dual-tracer protocols. In addition, the degree of certainty of localization was greater with the 2 dual-tracer protocols than the single-tracer protocol (P < 0.001). |
2 |
| 55. Cho NL, Gawande AA, Sheu EG, Moore FD Jr, Ruan DT. Critical role of identification of the second gland during unilateral parathyroid surgery: a prospective review of 119 patients with concordant localization. Arch Surg. 146(5):512-6, 2011 May. |
Observational-Dx |
324 patients |
To validate the effectiveness of a protocol for primary hyperparathyroidism in which intraoperative parathyroid hormone measurement (IOPTH) was not routinely used during minimally invasive parathyroidectomy for patients with dual localization by technetium Tc 99m sestamibi (MIBI) and ultrasonography and hypothesized that our rate of surgical failure would be less than 3% for patients with concordant localization. |
A total of 324 patients with primary hyperparathyroidism underwent parathyroid exploration between October 1, 2005, and September 30, 2009. In 136 patients (42.0%), imaging was concordant by MIBI and ultrasonography, and 119 patients were scheduled for MIP. Our protocol for MIP without IOPTH was successful in 115 patients (97%), with 13 cases converted to bilateral exploration based on intraoperative suspicion of multiglandular disease. Eight of 13 conversions (62%) revealed multiglandular disease that was undetected on imaging, 6 of which were apparent from examination of the ipsilateral second parathyroid gland. Four of 136 patients (3%) had persistent postoperative hypercalcemia necessitating reoperation, and all 4 had an adjacent but unseen second adenoma. There was no significant difference in the surgical cure rate following MIP without IOPTH for this prospective study vs a previously published retrospective analysis by our group (97% vs 98%, P = .47). |
2 |
| 56. Glynn N, Lynn N, Donagh C, et al. The utility of 99mTc-sestamibi scintigraphy in the localisation of parathyroid adenomas in primary hyperparathyroidism. Ir J Med Sci. 180(1):191-4, 2011 Mar. |
Observational-Dx |
57 patients |
To evaluate the overall sensitivity of this modality in parathyroid tumour localisation and to determine clinical and biochemical factors which influence sensitivity of this method. |
The sensitivity of sestamibi scanning was 56% in whole group and 63% in those without nodular thyroid disease. Among the patients with confirmed single gland disease (biochemical cure after surgical removal of a single adenoma), sensitivity was 71%. A positive scan was associated with younger age, greater adenoma weight and higher pre-operative serum calcium. Concordance between the sestamibi and neck ultrasonography was 92% accurate in pre-operative tumour localisation. |
2 |
| 57. Kim D, Rhodes JA, Hashim JA, et al. Highly specific preoperative selection of solitary parathyroid adenoma cases in primary hyperparathyroidism by quantitative image analysis of the early-phase Technetium-99m sestamibi scan. J Med Imaging Radiat Oncol. 62(5):642-648, 2018 Oct. |
Observational-Dx |
109 patients |
To hypothesize that Tc-99m sestamibi scan interpretation incorporating numerical measurements on the degree of asymmetrical activity from bilateral thyroid beds can be useful in localizing single adenoma for MIP. |
Receiver operating curve analysis revealed the area under the curve (AUC) was calculated to be 0.71 (P = 0.0032), validating this method as a diagnostic tool. The optimal cut-off point for the ratio value with maximal combined sensitivity and specificity was found with corresponding sensitivity of 67.9% (56.5-77.2%, 95% CI) and specificity of 75.0% (52.8-91.8%, 95% CI). An additional higher cut-off with higher specificity with minimal possible sacrifice on sensitivity was also selected, yielding sensitivity of 28.6% (18.8-38.6%, 95% CI) and specificity of 90.0% (69.6-98.8%, 95% CI). |
1 |
| 58. Medas F, Erdas E, Longheu A, et al. Retrospective evaluation of the pre- and postoperative factors influencing the sensitivity of localization studies in primary hyperparathyroidism. Int J Surg. 25:82-7, 2016 Jan. |
Observational-Dx |
212 patients |
To evaluate what pre- and post-operative factors may alter the reliability of localization studies. |
US sensitivity was 62.4% and MIBI sensitivity 78.9%. Cure rate after parathyroidectomy was 98.1%. Univariate logistic regression demonstrated that US sensitivity was impaired by lower levels of serum calcium (p < 0.0001), multi-gland disease (p = 0.011) and co-existence of thyroid disease (p = 0.001); MIBI sensitivity was impaired by lower levels of serum calcium (p = 0.001) and multi-gland disease (p < 0,0001). |
2 |
| 59. Raruenrom Y, Theerakulpisut D, Wongsurawat N, Somboonporn C. Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism. Nucl Med Rev Cent East Eur. 21(1):20-25, 2018. |
Observational-Dx |
63 patients |
To compare the diagnostic accuracy of various parathyroid scintigraphy protocols. |
A total of 63 patients underwent parathyroid scintigraphy and subsequent parathyroid surgery with a total of 106 excised lesions with histopathological diagnosis. On a lesion-based analysis, sensitivity and specificity (with 95% confidence interval) of protocols were as follows. DT protocol: 69.4% (53.1-82.0%) and 80.0% (49.0-94.3%); DP protocol: 78.6% (52.4-92.4%) and 33.3% (9.7-70.0%); DTDP protocol: 64.7% (47.9-78.5%) and 50.0% (18.8-81.2%); SPECT: 92.3% (66.7-98.6%) and 75.0% (30.1-95.4%); SPECT/CT: 80.0% (49.0-94.3%) and 75.0% (30.1-95.4%). All protocols had perfect sensitivity for detection of parathyroid adenoma whereas SPECT was the most sensitive method for detection of hyperplastic parathyroid glands. |
2 |
| 60. Smith RB, Evasovich M, Girod DA, et al. Ultrasound for localization in primary hyperparathyroidism. Otolaryngol Head Neck Surg. 149(3):366-71, 2013 Sep. |
Observational-Dx |
220 patients |
To evaluate the capability of ultrasound for preoperative localization in primary hyperparathyroidism. |
Preoperative ultrasonography, sestamibi scintigraphy, or both were obtained in 77%, 93%, and 69% of the patients, respectively. Preoperative ultrasonography and sestamibi scintigraphy localized an abnormality in 71% and 79% of patients, respectively. At the time of surgery, the localization by ultrasound was accurate in 82%. The accuracy of localization was similar for sestamibi scintigraphy (85%). In patients with inaccurate ultrasound localization, the sestamibi scintigraphy correctly identified the site of disease in only 45%. In patients with a nonlocalizing ultrasound, sestamibi scintigraphy was able to localize disease in only 47%, with 2 being in the mediastinum. |
2 |
| 61. Thomas DL, Bartel T, Menda Y, Howe J, Graham MM, Juweid ME. Single photon emission computed tomography (SPECT) should be routinely performed for the detection of parathyroid abnormalities utilizing technetium-99m sestamibi parathyroid scintigraphy. Clin Nucl Med. 34(10):651-5, 2009 Oct. |
Observational-Dx |
36 patients |
To determine whether DP SPECT (DPS) is significantly superior to DP planar (DPP) imaging in the detection of these abnormalities, justifying its routine use with Tc-99m MIBI parathyroid scintigraphy. |
All 36 patients were shown to have either 1 PA (n=27), 2 PAs (n=1), or PH (n=8). Overall, 29 adenomas and 24 hyperplastic glands were found at surgery. On a per patient basis, the sensitivity for the detection of PA or PH for DPP was 42% (15/36) compared with 67% (24/36) for DPS (P = 0.03). For the detection of PAs, the sensitivity of DPP was 54% (15/28) versus 79% (22/28) for DPS (P = 0.05), whereas for the detection of PH, the sensitivities were 0% (0/8) for DPP versus 25% (2/8) for DPS (P = 0.13). There were 2 false-positive scans using DPP versus only 1 false-positive scan with DPS, resulting in false-positive rates of 7% and 4%, respectively. The combination of DPP and DPS did not add any advantage in detecting either PA or PH compared with DPS alone. |
2 |
| 62. Wong KK, Fig LM, Gross MD, Dwamena BA. Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT: a meta-analysis. Nucl Med Commun. 36(4):363-75, 2015 Apr. |
Meta-analysis |
24 Studies |
To determine the diagnostic utility of parathyroid scintigraphy with technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) for localization of parathyroid adenoma. |
A total of 24 studies published between January 2003 and March 2014 with 1276 patients (334 men, 762 women, and 180 of unspecified sex) met the inclusion criteria. Data on the test performance of dual-phase 99mTc-sestamibi SPECT/CT showed an estimated pooled sensitivity (per-patient analysis) of 0.86 [confidence interval (CI) 0.81-0.90]. Sensitivity of SPECT/CT was superior to that of SPECT (0.74; CI 0.66-0.82) and planar (0.70; CI 0.61-0.80) techniques. Heterogeneity was present in the reported literature (I2=80.3%). The rate of ectopic parathyroid adenomas ranged between 4 and 20% and SPECT/CT was superior to SPECT and planar imaging for localization of ectopic sites. |
Good |
| 63. Xue J, Liu Y, Ji T, et al. Comparison between technetium-99m methoxyisobutylisonitrile scintigraphy and ultrasound in the diagnosis of parathyroid adenoma and parathyroid hyperplasia. Nucl Med Commun. 39(12):1129-1137, 2018 Dec. |
Observational-Dx |
187 patients |
To evaluate the value of technetium-99m methoxyisobutylisonitrile (Tc-MIBI) imaging and ultrasound in preoperative localization of parathyroid adenoma (PA) and parathyroid hyperplasia (PH). |
As per patient-based analysis, the sensitivity of ultrasound, Tc-MIBI DPS, and SPECT/CT was 90.70% (39/43), 95.56% (43/45), and 100.00% (30/30), respectively, for PA, and 93.55% (116/124), 90.85% (129/142), and 93.10% (108/116), respectively, for PH. There were no significant differences in sensitivity of these three imaging methods between PA and PH. However, per lesion-based analysis, the accuracy of ultrasound, Tc-MIBI DPS, and SPECT/CT in detecting PA was 78.43% (40/51), 86.79% (46/53) and 96.88% (31/32), respectively, and the accuracy of Tc-MIBI DPS was higher than that of ultrasound (?=6.507, P=0.011), and for PH, it was 49.69% (160/322), 40.71% (171/420), and 43.80% (152/347), respectively. The accuracy of ultrasound was higher than that of Tc-MIBI DPS (?=5.940, P=0.015). The accuracy of a combination of all three examinations of ultrasound+Tc-MIBI DPS, ultrasound+Tc-MIBI SPECT/CT, Tc-MIBI DPS+SPECT/CT, and ultrasound+Tc-MIBI DPS+Tc-MIBI SPECT/CT was 51.51% (154/299), 53.85% (161/299), 50.17% (150/299), and 54.18% (162/299), respectively, which was higher than that of ultrasound (?=5.273, P=0.022; ?=8.226, P=0.004; ?=3.880, P=0.049; ?=8.702, P=0.003, respectively). Serum levels of PTH and phosphorus were lower in patients with PA than in patients with PH (P<0.001), and serum calcium level, the weight, and the longest diameter of lesion and early uptake rate of Tc-MIBI DPS were higher in patients with PA than in patients with PH (P<0.01). Serum PTH level is often less than 1000?pg/ml in PA, but usually more than 1000?pg/ml in PH. |
2 |
| 64. Bahador FM, Latifi HR, Grossman SJ, Oza UD, Xu H, Griffeth LK. Optimal interpretative strategy for preoperative parathyroid scintigraphy. Clin Nucl Med. 40(2):116-22, 2015 Feb. |
Observational-Dx |
292 patients |
To retrospectively compare various scintigraphic methods to determine their relative accuracies and interobserver variabilities in preoperative localization of single-gland disease in patients with primary hyperparathyroidism. |
The accuracy of ALL imaging for delineating abnormal/normal parathyroid glands by quadrant was 96%, 93%, 95%, and 95% for the 4 readers. The accuracies of visual subtraction of early MIBI and I images and all planar images were not significantly different from ALL for all 4 readers. All planar and SPECT images were significantly more accurate than early MIBI only, delayed MIBI only, or SPECT only for all 4 readers and better than comparison of dual-phase early and delayed MIBI for 3 of 4 readers. |
1 |
| 65. Leslie WD, Dupont JO, Bybel B, Riese KT. Parathyroid 99mTc-sestamibi scintigraphy: dual-tracer subtraction is superior to double-phase washout. Eur J Nucl Med Mol Imaging 2002;29:1566-70. |
Observational-Dx |
88 patients |
To discuss the use of both dual-tracer subtraction and double-phase single-tracer washout techniques |
We blindly reviewed 88 consecutive cases of surgically explored hyperparathyroidism that had undergone preoperative scintigraphic localization with this procedure. Images were reformatted to display subtraction-only, early/delayed sestamibi-only and combined images. Scans were reviewed in random order. Of the 68 cases with solitary parathyroid adenoma, the sestamibi-only images gave correct localization in 49 (72%) while there was a statistically significant improvement in accuracy using the subtraction-only images (58 of 68, 85%, P=0.05) and the combined images (61 of 68, 90%, P=0.0015). Reader confidence was also greater with the subtraction-only and combined images than with the sestamibi-only images. Scan performance with parathyroid hyperplasia was less satisfactory. Although the largest gland was usually correctly identified, hyperplasia was difficult to distinguish from a solitary adenoma. Dual-tracer subtraction parathyroid imaging is superior to double-phase sestamibi-only imaging. The washout data may provide additional information in some cases, however, and an approach that combines both techniques may be optimal. |
1 |
| 66. Gomez-Ramirez J, Sancho-Insenser JJ, Pereira JA, Jimeno J, Munne A, Sitges-Serra A. Impact of thyroid nodular disease on 99mTc-sestamibi scintigraphy in patients with primary hyperparathyroidism. Langenbecks Arch Surg. 395(7):929-33, 2010 Sep. |
Observational-Dx |
236 patients |
To assess the impact of concomitant TND in the preoperative image studies. |
MIBI showed a sensitivity of 78.5% in patients without concomitant TND, 73% in patients with TND but not thyroidectomy needed, and 54.5% in the cases that thyroid resection was necessary. When MIBI and ultrasound were both suspicious for an adenoma, the sensitivity was not influenced by the TND. |
2 |
| 67. Alagaratnam S, Brain C, Spoudeas H, et al. Surgical treatment of children with hyperparathyroidism: single centre experience. J Pediatr Surg. 49(11):1539-43, 2014 Nov. |
Review/Other-Dx |
29 children |
To discuss the surgical treatment of children with hyperparathyroidism: single centre experience. |
We identified 29 children who had surgery for HPT. Six were neonates with neonatal severe hyperparathyroidism (NSHPT) and 23 older children (age range 7-16 years) with sporadic (16) or familial (7) HPT and 93% were symptomatic. Accuracy of ultrasound and MIbi in localising solitary parathyroid adenomas was 96%, but less helpful in hyperplasia and neonates. Children with NSHPT underwent 5 curative total and 1 subtotal PTx (no reoperations). Children with familial HPT underwent 3 total and 4 subtotal PTx. One child with subtotal PTx required a reoperation. Children with sporadic HPT underwent subtotal PTx prior to 1980 (2), exploration and removal of enlarged glands 1980-2002 (5) and minimally invasive PTx since 2002 (9) and all cured by the first operation. |
4 |
| 68. Greenspan BS, Dillehay G, Intenzo C, et al. SNM practice guideline for parathyroid scintigraphy 4.0. J Nucl Med Technol. 40(2):111-8, 2012 Jun. |
Review/Other-Dx |
N/A |
To assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of parathyroid imaging. |
No results stated in the abstract. |
4 |
| 69. Eslamy HK, Ziessman HA. Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT. Radiographics 2008;28:1461-76. |
Review/Other-Dx |
N/A |
To discuss the parathyroid scintigraphy in patients with primary hyperparathyroidism |
No results stated in the abstract. |
4 |
| 70. Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 19(2):577-83, 2012 Feb. |
Meta-analysis |
43 studies |
To investigate the accuracy of ultrasound, sestamibi-SPECT, and 4D-CT for preoperative localization in primary hyperparathyroidism (pHPT). |
43 studies met criteria for inclusion, and data were available for extraction in 19 ultrasound, 9 sestamibi-SPECT, and 4 4D-CT studies. Ultrasound had pooled sensitivity and positive predictive value (PPV) of 76.1% (95% CI 70.4-81.4%) and 93.2% (90.7-95.3%), respectively. Sestamibi-SPECT had pooled sensitivity and PPV of 78.9% (64-90.6%) and 90.7% (83.5-96.0%), respectively. Only two 4D-CT studies investigated patients undergoing initial parathyroidectomy. Results suggested sensitivity and PPV of 89.4% and 93.5%, respectively. |
Good |
| 71. Galvin L, Oldan JD, Bahl M, Eastwood JD, Sosa JA, Hoang JK. Parathyroid 4D CT and Scintigraphy: What Factors Contribute to Missed Parathyroid Lesions?. Otolaryngol Head Neck Surg. 154(5):847-53, 2016 05. |
Observational-Dx |
40 patients |
To determine the prevalence of missed lesions for parathyroid 4-dimensional computed tomography (4D CT) and scintigraphy and to describe the factors leading to missed lesions for both modalities. |
Of the 40 patients, 6 had multigland disease, resulting in 51 lesions; 12 and 29 lesions were missed on 4D CT and scintigraphy, respectively. The sensitivity for detection of all lesions was 76% for 4D CT and 43% for scintigraphy. Sensitivities for single-gland disease were 88% for 4D CT and 50% for scintigraphy. Sensitivities for multigland disease were 53% for 4D CT and 24% for scintigraphy. Rates of multigland disease in patients with missed lesions were 75% on 4D CT and 48% on scintigraphy, as compared with patients with detected lesions, 23% and 18%, respectively (P = .04). Mean weight of lesions missed on 4D CT was 0.3 and 0.6 g in detected lesions (P = .15). Mean weight of lesions missed on scintigraphy was 0.4 and 0.8 g in detected lesions (P = .03). |
2 |
| 72. Swanson TW, Chan SK, Jones SJ, et al. Determinants of Tc-99m sestamibi SPECT scan sensitivity in primary hyperparathyroidism. Am J Surg. 199(5):614-20, 2010 May. |
Review/Other-Dx |
176 patients |
To evaluate the influence of patient and adenoma characteristics on (99m)Tc-methoxy isobutyl isonitrile (MIBI) scan performance in individuals diagnosed with primary hyperparathyroidism (PHP). |
The overall true-positive (TP) rate for (99m)Tc-MIBI scans was 56%. Adenomas sized 1.9 to 3.5 cm were more likely to have TP scans than 0.3-cm to 1.8-cm adenomas (74% vs 40%, P < .001). Preoperative ionized calcium levels between 1.49 and 1.72 mmol/L were more likely to have TPs than levels between 1.27 and 1.48 mmol/L (65% vs 47%, P < .05). No single class of medication was shown to significantly effect TP rates. A decrease in TP rate was observed for larger adenomas in patients on >or=1 medication (74% vs 65%, P = .05). |
4 |
| 73. Nichols KJ, Tronco GG, Palestro CJ. Influence of Multigland Parathyroid Disease on 99mTc-Sestamibi SPECT/CT. Clin Nucl Med. 41(4):282-8, 2016 Apr. |
Observational-Dx |
246 patients |
To perform for preoperative parathyroid lesion localization in patients with primary hyperparathyroidism. |
Three hundred one parathyroid lesions were excised at surgery. Thirty-nine patients (16%) had MGD, and 207 patients (84%) had SGD; 26 patients had 2 lesions, 10 had 3 lesions, and 3 had 4 lesions. Lesion weights were significantly lower in MGD than in SGD (390 ± 604 vs 866 ± 933 mg, P < 0.0001) and decreased with increasing numbers of lesions (P < 0.0001). MIBI SPECT/CT was less sensitive for MGD than SGD (66% vs 98%, P < 0.0001). Sensitivity was lower for 66 MGD lesions matched to 66 SGD lesions (64% vs 98%, P < 0.0001) and decreased with increasing lesion numbers (? = -0.45, P < 0.0001), despite similar weights (526 ± 678 vs 525 ± 686 mg, P = 0.99) and similar locations (P = 0.47). Specificity was similar for MGD (95%) and SGD (90%). |
2 |
| 74. Bhatt PR, Klingensmith WC 3rd, Bagrosky BM, et al. Parathyroid Imaging with Simultaneous Acquisition of 99mTc-Sestamibi and 123I: The Relative Merits of Pinhole Collimation and SPECT/CT. J Nucl Med Technol. 43(4):275-81, 2015 Dec. |
Observational-Dx |
59 patients |
To determine the relative utility of 3 state-of-the-art parathyroid imaging protocols: single-time-point simultaneous acquisition of (99m)Tc-sestamibi and (123)I images with pinhole collimation in the anterior and bilateral anterior oblique projections, single-time-point simultaneous acquisition of (99m)Tc-sestamibi and (123)I images with SPECT/CT, and the combination of the first and second protocols. |
The 59 patients had 61 adenomas. For the 2 observers combined, the localization success rate was 88% for the pinhole protocol, 69% for the SPECT/CT protocol, and 81% for the combined protocol. The pinhole protocol detected more adenomas than the SPECT/CT protocol and missed fewer adenomas than either the SPECT/CT protocol or the combined pinhole and SPECT/CT protocol (P < 0.01). The 2 protocols that included SPECT/CT provided superior anatomic information relative to the location and size of the parathyroid adenomas. |
3 |
| 75. Hassler S, Ben-Sellem D, Hubele F, Constantinesco A, Goetz C. Dual-isotope 99mTc-MIBI/123I parathyroid scintigraphy in primary hyperparathyroidism: comparison of subtraction SPECT/CT and pinhole planar scan. Clin Nucl Med. 39(1):32-6, 2014 Jan. |
Observational-Dx |
50 patients |
To compare planar scans (neck and mediastinum parallel-hole, associated with anterior neck pinhole) to neck and mediastinum SPECT/CT, all with subtraction (I/Tc-MIBI) method, in exact location of abnormal parathyroid in 50 patients with sporadic primary hyperparathyroidism. |
Sensitivity is equivalent for the 2 protocols (86% and 75% for SPECT/CT and planar protocol, respectively, P = 0.15), but SPECT/CT was highly specific (specificity 100% and 90% for SPECT/CT and planar protocol, respectively, P = 0.04). In patients with concomitant thyroid disease, subtraction SPECT/CT appeared to be more sensitive than planar protocol (88% and 62% for SPECT/CT and planar protocol, respectively, P = 0.04). |
2 |
| 76. Lee GS, McKenzie TJ, Mullan BP, Farley DR, Thompson GB, Richards ML. A Multimodal Imaging Protocol, (123)I/(99)Tc-Sestamibi, SPECT, and SPECT/CT, in Primary Hyperparathyroidism Adds Limited Benefit for Preoperative Localization. World J Surg. 40(3):589-94, 2016 Mar. |
Observational-Dx |
360 patients |
To discuss the review of patients with primary hyperparathyroidism (1°HPT), who underwent parathyroidectomy. |
Of 360 patients who were identified, a curative operation was performed in 96%, using pre-operative imaging and IOPTH. Imaging analysis showed that (123)I/(99)Tc-sestamibi had a sensitivity of 86% (95% CI 82-90%), positive predictive value (PPV) 93%, and accuracy 81%, based on correct lateralization. SPECT had a sensitivity of 77% (95% CI 72-82%), PPV 92% and accuracy 72%. SPECT/CT had a sensitivity of 75% (95% CI 70-80%), PPV of 94%, and accuracy 71%. There were 3 of 45 (7%) patients with negative sestamibi imaging that had an accurate SPECT and SPECT/CT. Of 312 patients (87%) with positive uptake on sestamibi (93% true positive, 7% false positive), concordant findings were present in 86% SPECT and 84% SPECT/CT. In cases where imaging modalities were discordant, but at least one method was true-positive, (123)I/(99)Tc-sestamibi was significantly better than both SPECT and SPECT/CT (p < 0.001). The inclusion of SPECT and SPECT/CT in 1°HPT imaging protocol increases patient cost up to 2.4-fold. |
2 |
| 77. Dy BM, Richards ML, Vazquez BJ, Thompson GB, Farley DR, Grant CS. Primary hyperparathyroidism and negative Tc99 sestamibi imaging: to operate or not?. Ann Surg Oncol. 19(7):2272-8, 2012 Jul. |
Observational-Dx |
2,681 patients |
To discuss the review of patients who underwent primary operation for 1HPT with a preoperative Tc99 sestamibi I-123 (MIBI) scan. |
A total of 2,681 patients had an operation for 1HPT with preoperative MIBI. MIBI imaging was negative in 136 (5.7 %). The negative MIBI group had a lower calcium (10.9 vs. 11.0 mg/ml, P=0.02), phosphorus (2.9 vs. 3.1 mg/dl, P<0.001), and urinary calcium (251 vs. 287 mg/ml, P=0.02) and no difference in parathyroid hormone, 25-OH vitamin D, or bone loss. Multigland resection was higher with a negative scan (32 vs. 13 %, P<0.001). A curative operation was performed in 90.4 % with a negative MIBI compared to 97.5 % with localization (P<0.001). Patients who underwent successful surgery despite a negative MIBI scan had lower calcium (10.8 vs. 11.1 mg/ml, P=0.04) and parathyroid hormone (98 vs. 196 pg/ml, P=0.03) than those not cured. Patients with both a negative ultrasound result and negative MIBI had a cure rate of 89 %. |
2 |
| 78. Guerin C, Lowery A, Gabriel S, et al. Preoperative imaging for focused parathyroidectomy: making a good strategy even better. EUR. J. ENDOCRINOL.. 172(5):519-26, 2015 May. |
Observational-Dx |
199 patients |
To compare the performances of parathyroid scintigraphy (PS), parathyroid ultrasonography (US), and the combination of both procedures for guiding a focused approach on the basis of modified interpretation criteria. |
A total of 127 patients underwent a focused approach and the remainder had bilateral cervicotomy. In 42 cases, a focused approach was not performed due to the absence of concordant results between US and PS for a single-gland abnormality. Four patients had persistent disease and three had recurrent disease. A localizing preoperative PS had a sensitivity of 93.3%, positive predictive value of 85.8%, negative predictive value of 73.0%, and accuracy of 83.4% for predicting uniglandular disease. Additional SPECT images accurately localize posterior adenomas that are often missed by US. Compared with PS, US had a lower sensitivity (P<0.01). Our imaging protocol also enabled diagnosis of multiglandular disease in 60.6%. |
2 |
| 79. Woods AM, Bolster AA, Han S, et al. Dual-isotope subtraction SPECT-CT in parathyroid localization. Nucl Med Commun. 38(12):1047-1054, 2017 Dec. |
Observational-Dx |
224 patients |
To investigate the accuracy of locating parathyroid adenomas using dual-Isotope subtraction single-photon emission computed tomography-computed tomography (SPECT-CT) in comparison with clinical follow-up and pathology findings from surgery. |
Out of the 224 patients, 135 patients had complete pathology and/or clinical follow-up data and were included in the analysis. The sensitivity of the subtraction SPECT-CT findings was measured to be 95%, with a specificity of 89% for the detection and localization of parathyroid adenomas. The positive predictive value was found to be 97% and the negative predictive value was found to be 83%. The accuracy of the technique was 94% in detecting parathyroid adenoma and 92% in accurate localization. |
2 |
| 80. Keane DF, Roberts G, Smith R, et al. Planar parathyroid localization scintigraphy: a comparison of subtraction and 1-, 2- and 3-h washout protocols. Nucl Med Commun. 34(6):582-9, 2013 Jun. |
Observational-Dx |
190 patients |
To compare the accuracies of planar subtraction and multiple washout images in the same group of patients. |
The overall accuracy of this combined protocol for correct localization of both the side and axial level of parathyroid adenomas was 81% (90% when considering the side of the adenoma alone). Of all the nuclear medicine images produced, subtraction was the most useful. The 1 and 2 h washout images were comparable but the 3 h image added no value. The accuracy of ultrasound imaging was 55% for the side and pole and 60% for the side of the adenoma. |
2 |
| 81. Powell DK, Nwoke F, Goldfarb RC, Ongseng F. Tc-99m sestamibi parathyroid gland scintigraphy: added value of Tc-99m pertechnetate thyroid imaging for increasing interpretation confidence and avoiding additional testing. Clin Imaging. 37(3):475-9, 2013 May-Jun. |
Observational-Dx |
116 patients |
To evaluate the benefit of adding a pertechnetate parathyroid scan (dual-isotope imaging) in the interpretation of sestamibi dual-phase parathyroid scintigraphy. |
By adding Tc-99m pertechnetate imaging, the interpretation of 17 scans (17/116=14.6%) was substantially altered. This included 5 scans (4%) that changed from negative to positive and 9 scans (8%) that changed from equivocal to positive, excluding ectopic tissue and directing minimally invasive surgery, without the need for further imaging, such as ultrasound, in 12% of cases. One examination changed from positive to negative. In addition, 2 scans changed from equivocal to negative, necessitating further preoperative imaging for the evaluation of additional pathology such as thyroid nodules and lymph nodes and the consideration of hyperplasia. Among the remaining 99 patients, Tc-99m pertechnetate scans may also have contributed to the diagnosis in the 66 positive Tc-99m MIBI scans by increasing confidence in the interpretation and obviating additional imaging. Ten cases remained equivocal. |
4 |
| 82. Berner AM, Haroon A, Nowosinska E, et al. Localization of parathyroid disease with 'sequential multiphase and dual-tracer' technique and comparison with neck ultrasound. Nucl Med Commun. 36(1):45-52, 2015 Jan. |
Observational-Dx |
64 patients |
To evaluate the accuracy of the sequential multiphase and dual-tracer (SMADT) technique utilizing technetium-99m pertechnetate (99mTcO4) and dynamic technetium-99m-2-methoxyisobutylisonitrile (99mTc-MIBI) with single-photon emission computed tomography/computed tomography (SPECT/CT) for localization of hyperfunctioning parathyroid tissue and compare the results with ultrasound (US). |
Eighty-six histological samples were resected. The sensitivity of SMADT for localization to individual glands was 70.6% [95% confidence interval (CI)=58.1-80.7%] and that for neck US was 60.3% (95% CI=47.7-71.8%, P=0.26). Specificity was 94.4% (95% CI=70.6-99.7%) for SMADT and 72.2% (95% CI=46.4-89.2%) for neck US (P=0.13). Sensitivities in multigland disease were 63.6% (95% CI=31.6-87.6%) for SMADT and 36.4% (95% CI=12.4-68.4%) for US (P=0.37) and in nodular thyroid disease were 83.8% (95% CI=67.3-93.2%) and 66.7% (95% CI=48.9-80.9%), respectively (P=0.07). |
2 |
| 83. Huang Z, Lou C. 99mTcO4-/99mTc-MIBI dual-tracer scintigraphy for preoperative localization of parathyroid adenomas. J Int Med Res. 47(2):836-845, 2019 Feb. |
Observational-Dx |
268 patients |
To investigate the accuracy of dual-tracer scintigraphy for locating parathyroid adenomas in patients with primary hyperparathyroidism (PHPT). |
The positive and negative predictive values of 99mTc-MIBI SPECT/CT were 92.0% and 71.3%, respectively, and the sensitivity, specificity, and accuracy were 88.3%, 79.2%, and 85.8%, respectively. The positive and negative predictive values of dual-tracer scintigraphy were 96.3% and 82.3%, respectively, and the sensitivity, specificity, and accuracy were 92.9%, 90.3%, and 92.2%, respectively. Youden's index for dual-tracer scintigraphy and 99mTc-MIBI SPECT/CT were 0.83 and 0.63, respectively. |
2 |
| 84. Pata G, Casella C, Besuzio S, Mittempergher F, Salerni B. Clinical appraisal of 99m technetium-sestamibi SPECT/CT compared to conventional SPECT in patients with primary hyperparathyroidism and concomitant nodular goiter. Thyroid. 20(10):1121-7, 2010 Oct. |
Observational-Dx |
33 patients |
To test the hypothesis that SPECT/CT may be superior to SPECT for parathyroid localization in patients with PHPT and NG. |
The sensitivity of SPECT/CT for correctly identifying the neck side containing an abnormal parathyroid was 93.7% versus 80% for SPECT (p?=?0.21, not significant [ns]). The specificity and PPV for this attribute were 92.9% and 93.7%, respectively, for SPECT/CT versus 87.5% and 88.9%, respectively, for SPECT (p?=?0.75 and 0.8, ns). SPECT/CT showed higher sensitivity than SPECT (87.5% vs. 55.6%; p?=?0.0001) and higher PPV (87.5% vs. 62.5%; p?=?0.0022) for correctly identifying the neck quadrant affected by PHPT. The specificity for this was 95.5% for SPECT/CT versus 88.5% for SPECT (p?=?0.26, ns). Mean operative time was shorter after SPECT/CT than after SPECT (38 vs. 56 minutes; p?=?0.034). One of the patients having SPECT/CT had double adenomas, and two had ectopic parathyroid glands, all of which were recognized preoperatively by this technique. Two of the patients having SPECT had double adenomas, and two had ectopic glands, none of which were recognized preoperatively. No patient had persistent or recurrent PHPT. |
2 |
| 85. Nafisi Moghadam R, Amlelshahbaz AP, Namiranian N, et al. Comparative Diagnostic Performance of Ultrasonography and 99mTc-Sestamibi Scintigraphy for Parathyroid Adenoma in Primary Hyperparathyroidism; Systematic Review and Meta- Analysis. [Review]. Asian Pac J Cancer Prev. 18(12):3195-3200, 2017 Dec 28. |
Meta-analysis |
188 studies |
To compare PS and US for localization of parathyroid adenoma with a systematic review and meta-analysis of the literature. |
Among 188 studies and after deletion of duplicated studies (75), a total of 113 titles and abstracts were studied. From these, 12 studies were selected. The meta-analysis determined a pooled sensitivity for scintigraphy of 83% [99% confidence interval (CI) 96.358 -97.412] and for ultra-sonography of 80% [99% confidence interval (CI) 76-83]. Similar results for specificity were also obtained for both approache. |
Not Assessed |
| 86. Stern S, Tzelnick S, Mizrachi A, Cohen M, Shpitzer T, Bachar G. Accuracy of Neck Ultrasonography in Predicting the Size and Location of Parathyroid Adenomas. Otolaryngol Head Neck Surg. 159(6):968-972, 2018 12. |
Observational-Dx |
410 patients |
To evaluate the accuracy of US for estimating both the size and the location of PTAs and the effect of operator expertise. |
The cohort included 410 patients. US correctly localized the adenoma in 76% of cases with a sensitivity of 76.2% and a positive predictive value of 86.8%. Measurements were least accurate for adenomas measuring <1 cm in diameter (24%). Scans made by a single senior operator specializing in the neck had a higher accuracy rate than scans made by multiple operators, with a significant difference for small adenomas ( P < .001). |
2 |
| 87. Untch BR, Adam MA, Scheri RP, et al. Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years. J Am Coll Surg. 212(4):522-9; discussion 529-31, 2011 Apr. |
Observational-Dx |
516 patients |
To determine the relative contributions of SUS and MIBI to accurately predict adenoma location. |
SUS accurately localized adenomas in 87% of patients (342/392), and MIBI correctly identified their locations in 76%, 383/503 (p < 0.001). In patients who underwent SUS first, MIBI provided no additional information in 92% (144/156). In patients who underwent MIBI first, 82% of the time (176/214) SUS was unnecessary (p = 0.015). In 32 patients SUS was falsely negative. The reason for these included gland location in either the deep tracheoesophageal groove (n = 9) or the thyrothymic ligament below the clavicle (n = 5), concurrent thyroid goiter (n = 4), or thyroid cancer (n = 1). In 13 cases, the adenoma was located in a normal ultrasound-accessible location but was missed by the preoperative exam. In the 32 ultrasound false-negative cases, MIBI scans were positive in 21 (66%). Of the 516 patients, 7.6% had multigland disease. Persistent disease occurred in 4 patients (1%) and recurrent disease occurred in 6 (1.2%). |
2 |
| 88. Butt HZ, Husainy MA, Bolia A, London NJ. Ultrasonography alone can reliably locate parathyroid tumours and facilitates minimally invasive parathyroidectomy. Ann R Coll Surg Engl. 97(6):420-4, 2015 Sep. |
Observational-Dx |
100 patients |
To present eight-year experience of Minimally invasive parathyroidectomy (MIP) using ultrasonography alone. |
Of the 100 patients (69% female) who underwent parathyroidectomy, 93 had MIP. The median age of all cases was 58 years (range: 19-90 years). All patients exhibited an elevated parathyroid hormone level (median: 19pmol) in the presence of hypercalcaemia (median: 2.86mmol/l, range: 2.54-3.94mmol/l). Conventional surgery was indicated in seven patients owing to the need for concurrent thyroidectomy. The median operative time was 30 minutes (range: 10-130 minutes). Ultrasonography localised parathyroid tumour position correctly in 98% of patients who underwent MIP, and in 97% across both MIP and non-MIP groups. Postoperative complications requiring treatment included pancreatitis and symptomatic hypocalcaemia. Follow-up review at 6-8 weeks demonstrated that 86% of open cases (6/7) and 94% of MIP cases (87/93) were rendered normocalcaemic. |
2 |
| 89. Tresoldi S, Pompili G, Maiolino R, et al. Primary hyperparathyroidism: can ultrasonography be the only preoperative diagnostic procedure?. Radiol Med (Torino). 114(7):1159-72, 2009 Oct. |
Observational-Dx |
77 patients |
To assess the role of ultrasonography (US) before surgical treatment of primary hyperparathyroidism. |
Surgery revealed 85 abnormal parathyroid glands in 77 patients (70 adenomas, 15 hyperplasias). The locations of the parathyroid glands were typical cervical (n=77), thyrothymic ligament (n=3), carotid sheath (n=2), and mediastinum (n=3). In two patients, intrathyroid microadenoma was diagnosed by histopathology. Seventy-four enlarged glands in 64 patients were correctly identified at US. Per-patient sensitivity and positive predictive values, respectively, were 84% (64/76) and 99% (64/65) for US, 68% (44/65) and 100% (44/44) for scintigraphy and 91% (59/65) and 98% (59/60) for both techniques combined. We weighed 63 out of 85 glands, obtaining a value of 1,004+/-1,564 mg; 460 mg (mean+/-standard deviation; median). |
3 |
| 90. Beland MD, Mayo-Smith WW, Grand DJ, Machan JT, Monchik JM. Dynamic MDCT for localization of occult parathyroid adenomas in 26 patients with primary hyperparathyroidism. AJR Am J Roentgenol. 196(1):61-5, 2011 Jan. |
Observational-Dx |
34 patients |
To evaluate the accuracy of dynamic contrast-enhanced 4D MDCT in the preoperative identification of parathyroid adenomas in patients with primary hyperparathyroidism (PHPT) and a history of failed surgery or unsuccessful localization on standard imaging. |
The mean sensitivity and specificity of the three readers for the precise CT localization of adenomas was 82% (range, 79-88%) and 92% (range, 75-100%), respectively. Overall interobserver reliability was excellent (? = 0.70; range, ? = 0.60-0.79). All adenomas resected at surgery showed a biochemical response and clinical response. The mean densities of the confirmed adenomas were 41, 128, 138, and 109 HU at 0, 30, 60, and 90 seconds, respectively. Level II lymph nodes identified in 10 patients showed significantly less enhancement at 30 (p = 0.0001) and 60 (p = 0.006) seconds compared with surgically proven adenomas. |
2 |
| 91. Erbil Y, Barbaros U, Yanik BT, et al. Impact of gland morphology and concomitant thyroid nodules on preoperative localization of parathyroid adenomas. Laryngoscope. 116(4):580-5, 2006 Apr. |
Observational-Dx |
125 patients |
To assess the effect of the presence of thyroid nodules, adenoma weight, and ectopic localization on the sensitivity of different imaging studies in patients with hyperparathyroidism. |
The overall sensitivity of low-frequency ultrasonography, high-frequency ultrasonography, Thallium-Technetium scintigraphy, sestamibi scintigraphy, and combined technique was 69%, 89%, 71%, 86%, and 98%, respectively. The sensitivity of these imaging studies was 94%, 100%, 94%, 96%, and 100%, respectively, in our patients with no thyroid nodules but decreased to 54%, 84%, 54%, 81%, and 79%, respectively, in the presence of thyroid nodules. The parathyroid adenoma weight in true-positive imaging studies was significantly higher than those in false-positive and false-negative imaging studies. The numbers of ectopic parathyroid adenomas were found to be higher in the group of parathyroid adenomas undetected with ultrasonography when compared with ultrasonographically detected adenomas. |
2 |
| 92. Hader C, Uder M, Loose RW, Linnemann U, Bertsch T, Adamus R. Selective Venous Blood Sampling for Hyperparathyroidism with unclear Localization of the Parathyroid Gland. ROFO Fortschr Geb Rontgenstr Nuklearmed. 188(12):1144-1150, 2016 Dec. |
Observational-Dx |
46 patients |
To evaluate the benefit of selective venous blood sampling (SVS) for the preoperative identification of parathyroid adenomas with unclear localization in non-invasive diagnostics. |
In 24 out of 26 SVS a significant PTH peak was found. 19 patients underwent surgery after SVS.?In 16 of these cases (84?%) the SVS peak was concordant with the intraoperative localization. Thus, SVS of all operated patients had a sensitivity of 94?%. Considering only patients with prior HPT surgery the sensitivity was 89?%. In none of the 26 examinations complications occurred. |
3 |
| 93. Witteveen JE, Kievit J, van Erkel AR, Morreau H, Romijn JA, Hamdy NA. The role of selective venous sampling in the management of persistent hyperparathyroidism revisited. EUR. J. ENDOCRINOL.. 163(6):945-52, 2010 Dec. |
Review/Other-Dx |
18 patients |
To determine the accuracy of selective venous sampling (SVS) for parathyroid hormone (PTH) in localizing residual hyperactive parathyroid glands in patients with persistent or recurrent hyperparathyroidism. |
The SVS was able to accurately localize 15 of the 20 pathological glands removed at revision surgery, representing a sensitivity of 75%. This sensitivity is significantly higher than that of Tc99m-MIBI-SPECT, which was only 30% (P=0.012). |
4 |
| 94. Alvarado R, Meyer-Rochow G, Sywak M, Delbridge L, Sidhu S. Bilateral internal jugular venous sampling for parathyroid hormone determination in patients with nonlocalizing primary hyperparathyroidism. World J Surg. 34(6):1299-303, 2010 Jun. |
Observational-Dx |
30 patients |
To evaluate the utility of bilateral internal jugular venous sampling (BIJVS) approach in a clinical setting. |
In group A, 17 of 30 patients (56%) had lateralization of the parathyroid hormone (PTH) levels, with 11 correctly lateralizing to the side of the adenoma, 5 lateralizing despite bilateral disease, and 1 lateralizing to the contralateral side. Of the remaining 13 patients in whom there was no lateralization, 3 had bilateral multigland disease, and 10 had a single parathyroid adenoma. In group B, 17 of 30 patients (56%) also had lateralization of PTH levels, with 15 lateralizing to the side of the adenoma and 2 to the contralateral side. Lateralization failed in the remaining 13 patients, although in all of these patients the calcium and PTH levels normalized postoperatively. The control group of patients without parathyroid disease (group C) demonstrated lateralization of PTH levels in 23 of 30 patients (76%). |
2 |
| 95. Carneiro-Pla D.. Effectiveness of "office"-based, ultrasound-guided differential jugular venous sampling (DJVS) of parathormone in patients with primary hyperparathyroidism. Surgery. 146(6):1014-20, 2009 Dec. |
Observational-Dx |
21 patients |
To evaluate the effectiveness of office based DJVS as the next method for localization when Surgeon-performed ultrasonography (SUS) is equivocal. |
In 17 of 21 (81%) patients, DJVS was correct in indicating the side of the abnormal gland. DJVS was incorrect in 2 and negative in 2 other patients. Bilateral neck explorations were performed in only 6 of 21 patients because of either multiglandular disease (3 patients), concomitant thyroidectomy (2 patients), or surgeon's judgment (1 patient). There were no complications from DJVS, and all patients became eucalcemic. |
2 |
| 96. Bunch PM, Kelly HR. Preoperative Imaging Techniques in Primary Hyperparathyroidism: A Review. [Review]. JAMA Otolaryngol Head Neck Surg. 144(10):929-937, 2018 10 01. |
Review/Other-Dx |
N/A |
To discuss the Preoperative Imaging Techniques in Primary Hyperparathyroidism. |
No results stated in the abstract. |
4 |
| 97. Ginsburg M, Christoforidis GA, Zivin SP, et al. Adenoma localization for recurrent or persistent primary hyperparathyroidism using dynamic four-dimensional CT and venous sampling. J Vasc Interv Radiol. 26(1):79-86, 2015 Jan. |
Observational-Dx |
28 patients |
To determine if parathyroid venous sampling (PVS) combined with four-dimensional (4D) computed tomography (CT) improves sensitivity and accuracy of identification of parathyroid adenoma in patients with recurrent or persistent primary hyperparathyroidism (pHPT) and negative technetium-99m methoxyisobutyl isonitrile ((99m)Tc-MIBI) and ultrasound (US) scans. |
Surgery was performed in 22 of 28 patients. Surgery identified 23 parathyroid adenomas, 1 carcinoma, and 2 hyperplastic glands in 20 patients. 4D-CT alone localized 11 lesions in 10 patients. PVS helped localize 13 additional lesions in nine more patients and clarified two lesions that were equivocal on 4D CT. Comparing 4D CT alone with 4D CT plus PVS, the sensitivity increased from 50% to 95% (P = .004), and accuracy increased from 55% to 91% (P = .022). PVS lateralization had a sensitivity of 93.3%, positive predictive value of 66.7%, and accuracy of 63.6%. |
2 |
| 98. Aschenbach R, Tuda S, Lamster E, et al. Dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck. Eur J Radiol. 81(11):3371-7, 2012 Nov. |
Observational-Dx |
30 patients |
To evaluate the use of dynamic magnetic resonance angiography for localization of hyperfunctioning parathyroid glands in the reoperative neck. |
In conventional MRI 19/30 true positives were detected with a sensitivity and specificity of 63.3% and 100%, respectively. However, by adding dynamic magnetic resonance angiography the detection rate increased to 28/30 true positives. Based on intraoperative findings, the sensitivity and specificity of dynamic magnetic resonance angiography were 93.3% and 100%, respectively. 99m-Tc-Sestamibi detected 24/30 true positives, sensitivity was 80%. |
2 |
| 99. Witteveen JE, Kievit J, Stokkel MP, Morreau H, Romijn JA, Hamdy NA. Limitations of Tc99m-MIBI-SPECT imaging scans in persistent primary hyperparathyroidism. World J Surg. 35(1):128-39, 2011 Jan. |
Observational-Dx |
19 patients |
To determine the value of Tc99m-MIBI-SPECT in localizing residual hyperactive parathyroid tissue in patients with persistent primary hyperparathyroidism (PHPT) after initial excision of one or more pathological glands. |
In patients with persistent PHPT, Tc99m-MIBI-SPECT accurately localized a pathological parathyroid gland in 33% of cases before reoperative parathyroidectomy, compared to 61% before first PTx for sporadic PHPT. The Tc99m-MIBI-SPECT scan accurately localized intra-thyroidal glands in 2 of 7 cases and a mediastinal gland in 1 of 3 cases either before initial or reoperative parathyroidectomy. |
2 |
| 100. Shin JJ, Milas M, Mitchell J, Berber E, Ross L, Siperstein A. Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery. Arch Surg. 146(12):1397-403, 2011 Dec. |
Observational-Dx |
203 patients |
To evaluate how LSs and CS direct operative strategy in patients being considered for reexploration. |
Of 203 patients, 27 were not explored owing to nonlocalizing studies. Of the remaining 176 patients, LSs accurately guided reexploration in 85%. However, when including the 27 nonexplored patients, the success of LSs decreased to 73%. The cure rate in reoperated patients was 96% but was reduced to 83% when including nonexplored patients. Of the reoperated patients, 83% had single-site disease and 17% had multiple-site disease. The positive predictive value of LSs in predicting single- or multiple-site disease was 92% and 73%, respectively. However, when stratified by CS, the positive predictive value increased to 95% for single-site disease and to 100% for multiple-site disease. |
3 |
| 101. Hamidi M, Sullivan M, Hunter G, et al. 4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease. Ann Surg Oncol. 25(5):1403-1409, 2018 May. |
Observational-Dx |
58 patients |
To determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent primary hyperparathyroidism (PHPT). |
A total of 62 lesions were identified intraoperatively among the 58 patients (6 with multigland disease) included in this investigation. 4D-CT missed 13 lesions identified intraoperatively, compared with 32 and 22 lesions missed by US and sestamibi, respectively. Sensitivity for correct lateralization of culprit lesions was 77.4% for 4D-CT, 38.5% for US, and 46% for sestamibi. 4D-CT was superior in lateralizing adenomas (49/62) compared with US (20/52; p < 0.001) and sestamibi (18/47; p < 0.001). The overall cure rate (6-month postoperative calcium < 10.7 mg/dL) was 89.7%. All patients with lesions correctly lateralized by 4D-CT were cured at 6 months. |
3 |
| 102. Mihai R, Simon D, Hellman P. Imaging for primary hyperparathyroidism--an evidence-based analysis. [Review] [126 refs]. Langenbecks Arch Surg. 394(5):765-84, 2009 Sep. |
Review/Other-Dx |
N/A |
To discuss the Imaging for Primary Hyperparathyroidism. |
We found evidence at level III leading to recommendations at grade B, that sestamibi scintigraphy is a recommended first test, but that US by an experienced investigator may be an alternative. MIP may be performed when both tests are concordant, and in case of only one test being positive, unilateral exploration and use of intraoperative PTH measurements are recommended. Bilateral neck exploration is used when both tests are negative. For reoperative procedures, repeat investigations are recommended, but also to use US-guided fine needle aspiration and PTH measurements as well as venous sampling. However, for reoperative procedures, the level of evidence is weaker-level IV, but recommendations still at grade B. |
4 |
| 103. Schalin-Jantti C, Ryhanen E, Heiskanen I, 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. 54(5):739-47, 2013 May. |
Observational-Dx |
21 patients |
To compare the performance of planar scintigraphy with (123)I/(99m)Tc-sestamibi, (99m)Tc-sestamibi SPECT (SPECT/CT), (11)C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism. |
Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%-79%) for (123)I/(99m)Tc-sestamibi, 19% (95% CI, 5%-42%) for SPECT/CT, 65% (95% CI, 43%-84%) for (11)C-methionine PET/CT, and 40% (95% CI, 19%-65%) for SVS (P < 0.01 for (123)I/(99m)Tc-sestamibi vs. SPECT/CT). The corresponding accuracy for the correct quadrant or more specific site was 48% (95% CI, 27%-69%) for (123)I/(99m)Tc-sestamibi, 14% (95% CI, 3%-36%) for SPECT/CT, 61% (95% CI, 39%-80%) for (11)C-methionine PET/CT, and 25% (95% CI, 9%-49%) for SVS (P < 0.02 for (123)I/(99m)Tc-sestamibi vs. SPECT/CT). In the 3 patients not cured, preoperative (123)I/(99m)Tc-sestamibi and SPECT/CT remained negative, SVS was false predictive in all, and (11)C-methionine PET/CT in 1. (11)C-methionine PET/CT accurately revealed the pathologic gland in 4 of 8 (50%) patients with a negative (123)I/(99m)Tc-sestamibi scan result, all of whom were biochemically cured after reoperation. |
2 |
| 104. Lebastchi AH, Aruny JE, Donovan PI, et al. Real-Time Super Selective Venous Sampling in Remedial Parathyroid Surgery. J Am Coll Surg. 220(6):994-1000, 2015 Jun. |
Observational-Dx |
3,643 patients |
To investigate the use of real-time super selective venous sampling (sSVS) in the setting of negative noninvasive imaging modalities. |
We extended the use of the rapid parathyroid hormone assay in the interventional radiology suite, generating near real-time data facilitating onsite venous localization by a dedicated interventional radiologist. The predictive value of real-time sSVS localization was investigated. Overall, sSVS correctly predicted the localization of the affected gland in 89% of cases. Of 31 patients who underwent sSVS, a significant rapid parathyroid hormone gradient was identified in 28 (90%), localizing specific venous drainage of a culprit gland. All patients underwent subsequent surgery and were biochemically cured, with the exception of one who had metastatic parathyroid carcinoma. Three patients with negative sSVS were also explored and cured. |
2 |
| 105. Sun PY, Thompson SM, Andrews JC, et al. Selective Parathyroid Hormone Venous Sampling in Patients with Persistent or Recurrent Primary Hyperparathyroidism and Negative, Equivocal or Discordant Noninvasive Imaging. World J Surg 2016;40:2956-63. |
Observational-Dx |
30 patients |
To assess the role of sPVS in the preoperative evaluation of patients with P-PHPT or R-PHPT and negative, equivocal, or discordant noninvasive imaging localization. |
Of 30 patients who underwent sPVS, 12 patients did not undergo surgical exploration due to negative or non-localizing PTH gradient (n = 8) or opted for medical management (n = 4). Of the 18 patients who underwent surgical exploration, 17 (94 %) had a positive PTH gradient and pathologic parathyroid tissue identified at surgery. Sensitivity and PPV of sPVS were 93 and 77 %, respectively, for all surgical cases, 86 and 60.0 % for cervical cases (n = 11), and 100 and 100 % for mediastinal cases (n = 7). Sixteen patients (89 %) were surgically cured. |
2 |
| 106. Lee JB, Kim WY, Lee YM. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism. Ann. surg. treat. res.. 89(6):300-5, 2015 Dec. |
Observational-Dx |
109 patients |
To evaluate the accuracy of preoperative ultrasonography (USG), CT, and (99m)Tc sestamibi scintigraphy (MIBI) in localizing enlarged parathyroid glands and to find the impact of correct localization in successful parathyroidectomy. |
USG (91.5%) had the highest sensitivity and MIBI (56.1%) had the lowest among 3 modalities. The sensitivity of combined USG and CT (95.0%) was the highest among combined 2 modalities. The combination of all 3 modalities (95.4%) had the highest sensitivity among the combinations of modalities. The reduction of ioPTH in patients with positive imaging localization (86.6%) was greater than negative imaging localization (84.2%), with no significant difference (P = 0.586). The recurrence or persistence of sHPT was not correlated with preoperative imaging localization (19 patients in negative, 16 in positive; P = 0.14). |
2 |
| 107. Hiramitsu T, Tomosugi T, Okada M, et al. Pre-operative Localisation of the Parathyroid Glands in Secondary Hyperparathyroidism: A Retrospective Cohort Study. Sci Rep 2019;9:14634. |
Observational-Dx |
298 patients |
To discuss the Pre-operative Localisation of the Parathyroid Glands in Secondary Hyperparathyroidism. |
Between June 2009 and January 2016, 291 patients underwent PTx for SHPT after pre-operative evaluations involving CT, US, and MIBI scans, and the diagnostic accuracies of these imaging modalities for identifying the parathyroid glands were evaluated in 177 patients whose intact parathyroid hormone (PTH) levels were <9?pg/mL after the initial PTx. Additional PTx procedures were performed on 7 of 114 patients whose intact PTH levels were >9?ng/mL after PTx, and the diagnostic validities of the imaging modalities for the remnant parathyroid glands were evaluated. A combination of CT, US, and MIBI scans achieved the highest diagnostic accuracy (75%) for locating bilateral upper and lower parathyroid glands before initial PTx. The accuracies of CT, US, and MIBI scans with respect to locating remnant parathyroid glands before additional PTx were 100%, 28.6%, and 100%, respectively. A combination of CT, US, and MIBI scans is useful for initial PTx for SHPT, and CT and MIBI scans are useful imaging modalities for additional PTx procedures. |
2 |
| 108. Yang J, Hao R, Yuan L, Li C, Yan J, Zhen L. Value of dual-phase (99m)Tc-sestamibi scintigraphy with neck and thoracic SPECT/CT in secondary hyperparathyroidism. AJR Am J Roentgenol. 202(1):180-4, 2014 Jan. |
Observational-Dx |
80 patients |
To compare the diagnostic value of early and delayed phase (99m)Tc-sestamibi SPECT/CT in the detection of parathyroid tissue to guide operative treatment of patients with sHPT. |
Early phase (99m)Tc-sestamibi SPECT/CT depicted 3.57 parathyroid glands (PTGs) and delayed phase (99m)Tc-sestamibi SPECT/CT depicted 3.55 PTGs per study. The specificity of both early and delayed phase (99m)Tc-sestamibi SPECT/CT in detecting PTGs was 100%. The (99m)Tc-sestamibi SPECT/CT images of 7 of 80 patients showed positive findings in the delayed phase and negative findings in the early phase. The (99m)Tc-sestamibi SPECT/CT images of 6 of 80 patients showed positive findings in the early phase and negative findings in the delayed phase. |
2 |
| 109. Li P, Liu Q, Tang D, et al. Lesion based diagnostic performance of dual phase 99mTc-MIBI SPECT/CT imaging and ultrasonography in patients with secondary hyperparathyroidism. BMC med. imaging. 17(1):60, 2017 Dec 12. |
Observational-Dx |
50 patients |
To evaluate the diagnostic performance of 99mTc-MIBI SPECT/CT and ultrasonography in patients with secondary hyperparathyroidism (SHPT), and explored the factors that affect the diagnostic performance. |
Forty-nine patients had a positive 99mTc-MIBI imaging results and 39 patients had positive ultrasonography results. The sensitivities of 99mTc-MIBI and ultrasonography were 98.00% and 78.00%, respectively. A total of 199 lesions were resected in 50 patients. Among them, 183 lesions were proved to be parathyroid hyperplasia. On per-lesion basis analysis, the sensitivity and specificity of 99mTc-MIBI and ultrasonography were 59.34% and 75.00% vs 46.24% and 80.00%, respectively. The Pearson correlation analysis showed that the serum AKP and PTH level had a significant linear association (r?=?0.699, P?<?0.001). The lesion diameter was a statistically significant predictive factor in predicting positive 99mTc-MIBI SPECT/CT. The optimal cutoff value for predicting positive 99mTc-MIBI results evaluated by ROC analysis in lesions diameter was 8.05 mm. |
2 |
| 110. Karipineni F, Sahli Z, Somervell H, et al. Are preoperative sestamibi scans useful for identifying ectopic parathyroid glands in patients with expected multigland parathyroid disease?. Surgery. 163(1):35-41, 2018 01. |
Observational-Dx |
149 patients |
To investigate the usefulness of obtaining preoperative sestamibi scans and ultrasonography of the neck in identifying ectopic glands in this group of patients. |
Of 2,975 parathyroidectomies performed during this period, 154 operations were performed in 149 patients who met the criteria. Of the 149 patients, 82 (55.0%) had secondary, 31 (20.8%) had tertiary, 23 (15.4%) had lithium-induced HPT, and 13 (10.1%) had multiple endocrine neoplasia syndrome; 86 ectopic glands were identified in 64 patients (43.0%). Sensitivity for identification of ectopic glands was 29% for sestamibi scan and 7% for ultrasonography, while 89% of mediastinal glands were localized by sestamibi scans and thoracotomy, thoracoscopy, or sternotomy occurred in 4.7% of patients. |
2 |
| 111. Meola M, Petrucci I, Calliada F, et al. Presurgical setting of secondary hyperparathyroidism using high-resolution sonography and color Doppler. Ultraschall Med. 32 Suppl 1:S74-82, 2011 Jan. |
Observational-Dx |
40 patients |
To assess:1. The diagnostic accuracy of US and the sensitivity for localizing parathyroid glands with a volume = 500 mm(3).2. To assess the parameters that define parathyroid glandular perfusion. |
The sensitivity, specificity, positive predictive value and accuracy of US were 74 %, 75 %, 98 %, and 74 %, respectively. The sensitivity for localizing glands with a volume = 500 mm(3) was 90 %. US and SM had a combined sensitivity of 83 %. The vascularization of parathyroid glands became more evident with increasing glandular volume. With CDI, the signs of hypervascularization (i. e. an enlarged feeding artery at the hilum, a peripheral arc of vascularity and/or ray-like endonodular vessels) were present in 77 % of glands with a volume = 500 mm(3). |
2 |
| 112. Kawata R, Kotetsu L, Takamaki A, Yoshimura K, Takenaka H. Ultrasonography for preoperative localization of enlarged parathyroid glands in secondary hyperparathyroidism. Auris Nasus Larynx. 36(4):461-5, 2009 Aug. |
Observational-Dx |
44 patients |
To compare glands detected on preoperative ultrasonography (US) with those resected during PTx to examine the usefulness and limitations of US. |
Assuming that four parathyroid glands are present in each patient, the total number of glands in the 44 patients was 176. Of the 176 glands, 139 were detected on preoperative US. However, 27 could not be resected. Therefore, the detection rate on US was 63.6% (112/176). Of 37 glands that could not be detected on preoperative US, 30 were detected during surgery, and resected. There was a positive correlation between the glandular volume measured on US and isolated gland weight. However, there was no correlation between the preoperative serum iPTH level and the sum of the four isolated gland weights. |
2 |
| 113. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
