SFEBES2013 Poster Presentations Bone (34 abstracts)
The utility of neck MRI in the localisation of parathyroid adenomas in primary hyperparathyroidism
Nigel Glynn 1 , Brian Pierce 1 , Arnold DK Hill 2 , Claire McHenry 1 , Diarmuid Smith 1 , Chris Thompson 1 , Frank Keeling 3 & Amar Agha 1
1Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland; 2Department of Surgery, Beaumont Hospital and RCSI Medical School, Dublin, Ireland; 3Department of Radiology, Beaumont Hospital and RCSI Medical School, Dublin, Ireland.
Neck ultrasound (US) can facilitate minimally invasive parathyroidectomy by providing fine anatomical detail of enlarged parathyroid adenomas in patients with primary hyperparathyroidism (PHPT). The role of neck MRI in US negative/equivocal cases remains unclear. We aimed to evaluate the performance of neck MRI in parathyroid tumour localisation in the setting of negative or equivocal neck US.
We performed a retrospective review of a consecutive series of 35 patients (29 women) with a biochemical diagnosis of PHPT who had neck MRI performed over the last 5 years. All patients had either negative neck US or discordant results between the US and the 99mTc-sestamibi scintigraphy. Data recorded included biochemical, radiological, surgical and histological variables.
The median serum calcium 2.86 mmol/l (range 2.66–3.55) and median PTH was 93 ng/ml (range 48–564). Seventeen patients underwent parathyroidectomy. Two patients did not achieve post-operative cure - one had confirmed multi-gland disease and the other had a failed neck exploration. Both patients had a negative MRI neck. The sensitivity of MRI was 47% in the whole group. However a positive MRI scan was 94% accurate in localising an enlarged parathyroid gland. Patient age, severity of hyperparathyroidism and adenoma weight were not predictive of a positive MRI scan.
In patients with primary hyperparathyroidism and non-diagnostic neck US or discordant imaging results, neck MRI can be useful with a high specificity although moderate sensitivity in adenoma localisation.
DOI: 10.1530/endoabs.31.P21
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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