SFEBES2017 Oral Communications Clinical Highlights (6 abstracts)
Additional value of 4D-CT in patients with primary hyperparathyroidism and negative conventional imaging; a reason to change primary imaging modality in patients over 60?
Gonnie Alkemade 1 , Mildred Sifontes-Dubón 1 , Dhruti Bhatt 1 , David Smith 2 , Rebecca Duguid 3 , Jack Straiton 4 , Jane Dymot 1 , Alex Graveling 1 & Prakash Abraham 1
1Department of Endocrinology, Aberdeen Royal Infirmary, Aberdeen, UK; 2Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, UK; 3Department of Radiation Protection, Aberdeen Royal Infirmary, Aberdeen, UK; 4Department of Clinical Radiology and Nuclear Medicine, Aberdeen Royal Infirmary, Aberdeen, UK.
Introduction: Minimally invasive surgical treatment of primary hyperparathyroidism (PHPT) requires optimal preoperative localisation imaging. Parathyroid four-dimensional CT (4D-CT) has been reported to provide greater sensitivity than MIBI-SPECT/CT in localizing parathyroid adenomas. We analysed the additional value of 4D-CT in our cohort of PHPT patients.
Materials and methods: Patients who attended our parathyroid clinic between February 2016 and April 2017, with biochemically unequivocal PHPT and meeting criteria for surgery were included. All patients underwent Ultrasound and MIBI-SPECT/CT. Patients with inconclusive imaging underwent additional 4D-CT.
Results: Fifty-two patients (77% female) with a mean age of 66.2±14.9 years were included. To date 17/23 patients with inconclusive imaging results underwent additional 4D-CT. Surgical correlation so far has been positive in 4/4 positive 4D-CTs. An intrathyroidal parathyroid adenoma was found in 1 patient with a negative 4D-CT.
| US | MIBI-SPECT/CT | 4D-CT | |
| Positive | 29/52 (55.8%) | 29/52 (55.8%) | 13/17 (76.4%) |
| Negative | 20/52 (38.5%) | 22/52 (42.3%) | 3/17 (17.6%) |
| Equivocal | 3/52 (5.7%) | 1/52 (1.9%) | 1/17 (5.9%) |
| MIBI-SPECT/CT | 4D-CT vs 4D-CT adjusted protocol | Annual UK Background Exposure | |
| Calculated exposure | 8.5 mSv | 18 mSv vs 12 mSv | 2.7 mSv |
Conclusions and discussion: We have been able to radiologically localize a parathyroid adenoma in a majority of our PHPT patients with inconclusive imaging. Surgical correlation is ongoing, but results so far are promising. 4D-CT incurs radiation exposure, particularly to the thyroid and therefore should be used cautiously, especially in younger patients. Population risk for developing any cancer is 1/1000 after 4D-CT, 1/1700 after 4D-CT adjusted protocol and 1/2400 after MIBI-SPECT/CT. Lifetime attributable risk for thyroid cancer after 4D-CT is 1/100,000 in patients >60 years vs 1/2600 in patients of 30 years. MIBI-SPECT/CT is five times more expensive than 4D-CT (£630 vs £125). Currently, first line imaging consists of Ultrasound and MIBI-SPECT/CT. 4D-CT has additional value in PHPT patients with negative conventional imaging. We suggest that 4D-CT should be considered as first line imaging in patients over 60 years presenting with PHPT. Optimising the sensitivity of parathyroid imaging should result in more patients having minimally invasive surgery.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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