Ali R. Sepahdari MD, Presenter: Nothing to Disclose

Manisha Bahl MD, MPH, Abstract Co-Author: Nothing to Disclose

Jenny K. Hoang MBBS, Abstract Co-Author: Nothing to Disclose

Parathyroid multigland disease (MGD) is a challenging problem for radiologists. Other lesions in the patient may be missed after the first lesion is detected because they are small or not suspected. We aim to compare 4DCT findings of single gland (SG) and MGD to identify findings that may predict MGD.

We retrospectively reviewed 35 patients with MGD and 129 patients with SG lesions who had preoperative 4DCT scans at two institutions between September 2011 and December 2013. The following data were recorded: presurgical calcium and PTH levels, number of candidate lesions identified with 4DCT, and longest measurement of abnormal glands seen on CT. Parametric and non-parametric statistical tests were applied in order to determine features or combinations of features that could predict MGD.

Mean size of MGD was 8.8 mm and significantly smaller than mean size 11.8 mm for SG lesions (p .001). MGD also had lower serum PTH (P=.03). Fisher’s exact test showed that identification of only 1 abnormal gland, versus no abnormal glands or multiple abnormal glands, was strongly predictive of single gland disease (P<.0001, likelihood ratio [LR] = 5). The finding of only 1 abnormal gland was 86% specific for single gland disease (14% missed MGD). Adding the requirement that the abnormal gland measure at least 10 mm in maximal dimension resulted in 94% specificity for SG disease (6% missed) (P<.0001, LR 8.5). 

Identification of a single abnormal gland measuring at least 10 mm on 4DCT is highly specific for single gland disease. Conversely, when the candidate lesion is less than 1cm, the radiologists should be more suspicious for MGD and review the scan closely for another lesion. This information can help radiologists to improve the sensitivity of future 4DCT interpretations for MGD.

Improving the detection of MGD or raising suspicion for MGD to the surgeons allows for a more informed clinical management plan and appropriate selection of patients for minimally invasive surgery.

Sepahdari, A, Bahl, M, Hoang, J, 4DCT in the Evaluation of Hyperparathyroidism: Predictors of Parathyroid Single Gland and Multigland Disease.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14016621.html