Accuracy of Four-dimensional CT for the Localization of Abnormal Parathyroid Glands in Patients with Primary Hyperparathyroidism

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Four-dimensional CT is an accurate method for the presurgical localization of parathyroid adenoma in patients with single-gland primary hyperparathyroidism and has the potential to be the sole imaging examination for this purpose.


To investigate multiphase multidetector four-dimensional computed tomography (CT) as a technique to correctly localize abnormal parathyroid glands in patients with primary hyperparathyroidism.

Materials and Methods

Informed consent was waived by the institutional review body for this retrospective, chart review study. Radiology reports from four-dimensional CT and surgical notes were reviewed in 143 patients with primary hyperparathyroidism (35 men, 108 women; median ages, 58 and 60 years, respectively) who underwent parathyroid surgery between August 2004 and January 2007 and in whom four-dimensional CT predicted a single lesion. Accuracy of four-dimensional CT was stratified by patient and was determined separately for localization to the correct side and quadrant (upper and lower for each side), with surgical findings serving as standard of reference.


In 143 patients, 148 abnormal parathyroid glands were found at surgery; 137 (93%) of these were weighed, with mean and median weights of 757 and 417 mg, respectively. Four-dimensional CT lateralized the abnormal glands with 93.7% accuracy (134 of 143). For localization according to quadrant, the accuracy was 86.6% (116 of 134).


Four-dimensional CT has sufficiently high accuracy in presurgical localization to allow confident performance of unilateral parathyroidectomy in patients with sporadic primary hyperparathyroidism. The superior accuracy compared with that of ultrasonography and technetium 99m sestamibi scanning may be sufficient to allow four-dimensional CT to be used as the sole presurgical localization method.

© RSNA, 2012


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Article History

Received May 2, 2011; revision requested July 12; revision received January 27, 2012; accepted February 8; final version accepted March 26.
Published online: Sept 2012
Published in print: Sept 2012