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Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans

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Abstract

Objectives

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).

Methods

Fifty-seven patients affected by PHPT were prospectively enrolled and underwent US, 99mTc-sestamibi and 3TMRI. T2-weighted and post-contrast T1-weighted Iterative decomposition of water and fat with Echo Asymmetry and Least squares estimation (IDEAL) sequences were acquired. Diagnostic performance of US, 99mTc-sestamibi and MRI in localising PTAs to correct quadrant were compared according to surgical and pathological findings.

Results

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.

Conclusions

Our study demonstrated high diagnostic performance of 3T MRI in the preoperative PTAs quadrant localisation, as well as in patients with multiglandular disease and ectopic PTAs. MRI may be preferred to adequately select patient candidates for minimally invasive parathyroidectomy (MIP).

Key Points

• PTA(s) quadrant localisation by 3TMRI was more accurate than US+99mTc-sestamibi.

• MRI identified all enlarged glands in multiglandular disease similarly to US.

• MRI identified 6/7 ectopic PTAs similarly to 99mTc-sestamibi.

• Presurgical PTA(s) localisation by 3TMRI select the optimal candidates for MIP.

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Abbreviations

CI:

Confidence interval

CT:

Computed tomography

MIP:

Minimally invasive parathyroidectomy

MRI:

Magnetic resonance imaging

PHPT:

Primary hyperparathyroidism

PPV:

Positive predictive value

PTA(s):

Parathyroid adenoma(s)

PTH:

Parathyroid hormone

US:

Ultrasound

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Interventional Radiology Unit, Ospedale M.G. Vannini – Figlie di San Camillo, Via dell’acqua Bullicante, 00100, Roma, Italy

    Renato Argirò

  2. Department of Radiological Sciences, Oncology and Pathology, Sapienza University, viale Regina Elena 324, 00161, Rome, Italy

    Renato Argirò, Daniele Diacinti, Beatrice Sacconi, Angelo Iannarelli, Davide Diacinti, Cira Di Gioia, Mario Bezzi & Carlo Catalano

  3. Center for Life Nano Science Sapienza, Istituto Italiano di Tecnologia, Viale Regina Elena, 291, Rome, Italy

    Beatrice Sacconi

  4. Department of Clinical Sciences, Sapienza University, viale del Policlinico 155, 00161, Rome, Italy

    Cristiana Cipriani, Jessica Pepe, Claudio Letizia & Salvatore Minisola

  5. Department of Clinical and Molecular Medicine, Sapienza University, via Grottarossa 1035, 00189, Rome, Italy

    Daniela Pisani

  6. Department of Experimental Medicine, Sapienza University, viale del Policlinico 155, 00161, Rome, Italy

    Elisabetta Romagnoli

  7. Department of Surgery Sciences, Sapienza University, viale del Policlinico 155, 00161, Rome, Italy

    Marco Biffoni

Authors
  1. Renato Argirò
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  2. Daniele Diacinti
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  10. Cira Di Gioia
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  11. Jessica Pepe
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  14. Salvatore Minisola
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  15. Carlo Catalano
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Corresponding author

Correspondence to Daniele Diacinti.

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The scientific guarantor of this publication is Prof. Carlo Catalano

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Institutional Review Board approval was obtained

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Written informed consent was obtained from all subjects (patients) in this study.

Methodology

• prospective

• observational study

• performed at one institution

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Argirò, 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, 4900–4908 (2018). https://doi.org/10.1007/s00330-018-5437-8

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  • DOI: https://doi.org/10.1007/s00330-018-5437-8

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