Mylene Thi MyTien Truong MD, Presenter: Nothing to Disclose

Jeremy John Erasmus MD, Abstract Co-Author: Nothing to Disclose

Reginald Frank Munden DMD, Abstract Co-Author: Nothing to Disclose

Gregory W. Gladish MD, Abstract Co-Author: Nothing to Disclose

Bradley S. Sabloff MD, Abstract Co-Author: Nothing to Disclose

Douglas B Evans MD, Abstract Co-Author: Nothing to Disclose

To compare multidetector CT (MDCT) and MRI in the preoperative localization of hyperfunctioning parathyroid glands.

24 patients with hyperparathyroidism confirmed by biochemical testing and sestamibi scintigraphy were referred for preoperative localization. 18 patients had no prior neck surgery and 6 patients had recurrent and/or persistent hyperparathyroidism, having undergone one or more prior surgical explorations. There were 17 women and 7 men with mean age 57.3 (range: 42-79). 12 patients had MDCT and 12 patients had MRI. MDCT was performed on a LightSpeed Plus QX/i scanner (General Electric Medical Systems, Milwaukee, WI) using 2.5-mm collimation, 40-120kVp, 200-320mA, 0.5 sec and 100ml of non-ionic intravenous contrast. MRI was performed using a neurovascular phased array coil, 3 - 5-mm images with a 1 mm interslice gap, transaxial T1-weighted spin echo sequence (TR 700 ms, TE 20 ms) and fast spin-echo (FSE) T2-weighted sequence (TR 3500-4000 ms, TE 85-102 ms), and post-contrast T1-weighted images with fat suppression. All patients underwent surgical resection. Studies were reviewed retrospectively and correlated with sestamibi scintigraphy.

Surgical resection revealed parathyroid adenomas (n=19) and hyperplasia (n=5). The size of the parathyroid glands identified by MDCT ranged from 6-13 mm (mean, 9 mm), and 8-30 mm (mean, 11 mm) by MRI. MDCT and MRI correctly identified hyperfunctioning parathyroid glands in 9 (75%) and 10 (83.3%) patients, respectively. Ectopic location was present in 4 (16.7%) patients, with parathyroid glands located in the tracheoesophageal groove in the neck (n=3) and anterior mediastinum (n=1). 2 of the 4 patients with ectopic location had prior neck surgery and both had MRI which correctly identified the ectopic location. The remaining 2 patients with ectopic location had CT which correctly identified parathyroid in the tracheoesophageal groove in the neck.

MDCT is more cost effective and easier for patients to tolerate than MRI. With similar sensitivity for detection of hyperfunctioning parathyroid glands, contrast-enhanced MDCT is a viable alternative to MRI.

R.F.M.: RFM is an uncompensated consultant for General Electric CT Advisory Board.

Truong, M, Erasmus, J, Munden, R, Gladish, G, Sabloff, B, Evans, D, Comparison of Multidetector CT and MRI in the Preoperative Localization of Hyperfunctioning Parathyroid Glands.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4413794.html