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Diagnostic value and clinical impact of complementary CT scan prior to surgery for non-localized primary hyperparathyroidism

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Abstract

Introduction

Successful localization is mandatory for focused parathyroidectomy. If ultrasound and sestamibi scan are negative, bilateral neck exploration is necessary. We examined the contribution of complementary computed tomography (CT) scan to identify the affected parathyroid gland.

Methods

Between November 1999 and April 2014, 25 patients (20 females and 5 males; mean age 67 ± 11 years) with negative or dubious standard imaging (ultrasound and sestamibi scan) underwent CT scan prior to parathyroidectomy and were included in this study. Fifteen patients had had previous neck surgery for parathyroidectomy (n = 11) or thyroidectomy (n = 4). Thin-slice CT (n = 9) or four-dimensional (4D) CT imaging (n = 16) was used. Cure was defined as >50 % post-excision fall of intraoperatively measured parathyroid hormone or fall into the normal range, confirmed by normocalcaemia at least 6 months after surgery.

Results

Preoperative CT scan provided correct localization in 13 out of 25 patients (52 %) and was false positive once. Parathyroidectomy was performed by a focused approach in 11 of these 13 patients as well as in 1 patient guided by intraoperatively measured parathyroid hormone (ioPTH). Thirteen patients required bilateral neck exploration. The cure rate was 96 % (24/25 patients). One patient has persistent primary hyperparathyroidism (pHPT) and one a recurrent disease. Six patients presented a multiglandular disease.

Conclusion

A CT scan identifies about half of abnormal parathyroid glands missed by conventional imaging and allows focused surgery in selected cases.

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Conflicts of interest

The manuscript has not been submitted to more than one journal for simultaneous consideration. The manuscript has not been published previously (partly or in full). The study is not split up into several parts and submitted to various journals. No data have been fabricated or manipulated (including images). Consent to submit has been received explicitly from all the co-authors before the work is submitted. The authors whose names appear on the submission have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. The authors have no conflict of interest.

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Authors and Affiliations

  1. Klinik für Chirurgie und Zentrum für Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Academic Teaching Hospital, University of Duisburg-Essen, Henricistraße 92, 45136, Essen, Germany

    B. Seeliger, P. F. Alesina, J. Hinrichs, B. Meier & M. K. Walz

  2. Klinik für Diagnostische und Interventionelle Radiologie, Kliniken Essen-Mitte, Academic Teaching Hospital, University of Duisburg-Essen, Henricistraße 92, 45136, Essen, Germany

    J.-A. Koch

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  1. B. Seeliger
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  2. P. F. Alesina
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  3. J.-A. Koch
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  4. J. Hinrichs
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  5. B. Meier
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  6. M. K. Walz
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Correspondence to P. F. Alesina.

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Seeliger, B., Alesina, P.F., Koch, JA. et al. Diagnostic value and clinical impact of complementary CT scan prior to surgery for non-localized primary hyperparathyroidism. Langenbecks Arch Surg 400, 307–312 (2015). https://doi.org/10.1007/s00423-015-1282-2

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  • DOI: https://doi.org/10.1007/s00423-015-1282-2

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