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Preoperative Localization for Primary Hyperparathyroidism Surgery: Comparison of Imaging Techniques at a Tertiary Center

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Abstract

Minimal access surgery for single or multi-glandular primary hyperparathyroidism requires precise preoperative localization. A multitude of imaging and nuclear medicine techniques are available to accomplish this. In this study, we compared techniques such as neck ultrasound, parathyroid scintigraphy, single-photon emission computed tomography and computed tomography (SPECT/CT), magnetic resonance imaging (MRI), and other methods in terms of sensitivity, specificity, and accuracy in localizing parathyroid disease. A single-center retrospective cohort study was carried out on selected adult patients with primary hyperparathyroidism who had undergone parathyroidectomy. Details of preoperative imaging were charted, coded, and analyzed to determine sensitivity, specificity, accuracy, and other parameters of various techniques for preoperative localization. Parathyroid scintigraphy scanning was the most sensitive and accurate procedure for functional imaging, followed closely by SPECT/CT. The specificity and positive predictive value were higher for SPECT/CT, and both modalities outperformed neck ultrasonography. For anatomical imaging, MRI and CT neck with IV contrast had high sensitivity, while neck U/S, SPECT/CT, and scintigraphy had higher specificity, but there were no significant differences between various modalities. Study concludes that SPECT/CT had excellent accuracy in detecting and localizing single-gland disease; an additional imaging technique such as CT neck with contrast or MRI was more useful in patients with multi-glandular disease.

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Authors and Affiliations

  1. Department of Otolaryngology Head and Neck Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Mohammed Alessa

  2. Resident Otolaryngology Head and Neck Surgery, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia

    Amani Algouhi, Ghada Alsowailmi & Abdullah Arafat

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  1. Mohammed Alessa
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  2. Amani Algouhi
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  3. Ghada Alsowailmi
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  4. Abdullah Arafat
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Alessa, M., Algouhi, A., Alsowailmi, G. et al. Preoperative Localization for Primary Hyperparathyroidism Surgery: Comparison of Imaging Techniques at a Tertiary Center. Indian J Surg (2022). https://doi.org/10.1007/s12262-022-03561-7

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  • DOI: https://doi.org/10.1007/s12262-022-03561-7

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