Davide Caramella MD, Presenter: Nothing to Disclose

Salvatore Mazzeo, Abstract Co-Author: Nothing to Disclose

Andrea Giannini, Abstract Co-Author: Nothing to Disclose

Silvia Giusti, Abstract Co-Author: Nothing to Disclose

Claudio Marcocci, Abstract Co-Author: Nothing to Disclose

Carlo Bartolozzi MD, Abstract Co-Author: Nothing to Disclose

To evaluate the accuracy of multislice CT in the detection of a parathyroid lesion in patients affected by primary hyperparathyroidism.

The study included 34 patients affected by primary hyperparathyroidism; the pre-operative first-level examination revealed: negative US findings in 26 cases and doubtful US findings in 8 cases; negative scintigraphic findings in 22 cases, doubtful findings in 9 cases and positive findings in 3 cases (cervical 1, mediastinum 2).In 15 cases (44%) a thyroid disease was associated (multinodular goiter in 11 cases; chronic thyroiditis in 4 cases). Two patients were affected by a recurrence of the primary hyperparathyroidism, while 2 patients were previously submitted to a negative surgical exploration. The CT study was performed before and after iv contrast medium administration (thickness 2,5 mm, recontruction interval 1.25mm). The volumetric acquisition included the neck and mediastinum. A parathyroid lesion was diagnosed on the basis of the morphology, localization of the nodule and its spatial relationship with vascular structures; the lesion enhancement was also compared with the thyroid parenchyma and lymph nodes enhancement.

The surgical intervention was performed in 27 patients. In these patients the CT examination revealed 13 cervical lesions, 8 lesions located at the cervico-mediastinal junction, 3 mediastinal nodules, 3 negative cases. The ectopic lesions were located: retroesophageal (3 cases), retrotracheal (1 case), submandibular (1 case), retrosternal space (1 case), near to aortic arch (2 cases). CT demonstrated 23 true positive cases, 1 false negative case, 1 false positive case , 2 true negative cases. The sensitivity and specificity values resulted 96% e 67% respectively, and diagnostic accuracy 92%.

Multislice CT is an accurate second-level diagnostic technique in the detection of a parathyroid lesion, allowing the exploration of the entire cervical and mediastinal regions. It can also detect the vascular structures afferent to the parathyroid nodule and permits to exclude other cervical masses (thyroid nodules and lymph nodes).

Caramella, D, Mazzeo, S, Giannini, A, Giusti, S, Marcocci, C, Bartolozzi, C, Multislice CT to Detect Parathyroid Lesions in Patients with Primary Hyperparathyroidism.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4413255.html