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Preoperative Parathyroid Imaging

Trends in Utilization and Comparative Accuracy of Sonography, Scintigraphy, and 4-Dimensional Computed Tomography

Bahl, Manisha, MD, MPH

Journal of Computer Assisted Tomography: March/April 2019 - Volume 43 - Issue 2 - p 264–268
doi: 10.1097/RCT.0000000000000821

Objective The purposes of this study were 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.

Methods A retrospective review of consecutive patients who underwent parathyroid surgery from 2009 to 2014 was performed. Utilization and accuracy were compared for sonography, scintigraphy, and 4DCT.

Results 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).

Conclusions Four-dimensional CT has the highest sensitivity for localization of parathyroid adenomas regardless of order of imaging or imaging algorithm.

From the Department of Radiology, Duke University Medical Center, Durham, NC.

Received for publication August 5, 2018; accepted September 14, 2018.

Correspondence to: Manisha Bahl, MD, MPH, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street (WAC 240), Boston, MA 02114 (e-mail:

Part of this project was presented by Dr Bahl at the American Roentgen Ray Society Meeting in April 2015. The title of the presentation was “4DCT Changes Imaging Utilization in Parathyroid Imaging: Five-Year Trends in Preoperative Imaging for 604 Patients.”

The author declares no conflict of interest.

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