Abstract
Our aim was to test the hypothesis that our recently introduced 4D-dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation. Inclusion criteria were the following: 1) confirmed biochemical diagnosis of primary hyperparathyroidism, 2) preoperative 4D-dynamic contrast-enhanced MR imaging, and 3) surgical cure with >50% decrease in serum parathyroid hormone intraoperatively. 4D-dynamic contrast-enhanced studies were reviewed independently by 2 neuroradiologists to identify the side, quadrant, and number of abnormal glands, and compared with surgical and pathologic results. Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease (9 with double-gland hyperplasia; 3 with 3-gland hyperplasia; and 5 with 4-gland hyperplasia). Interobserver agreement (κ) for the side (right versus left) was 0.92 for single-gland disease and 0.70 for multigland disease. Interobserver agreement for the quadrant (superior versus inferior) was 0.70 for single-gland disease and 0.69 for multigland disease. For single-gland disease, the gland was correctly located in 34/37 (92%) patients, with correct identification of the side in 37/37 (100%) and the quadrant in 34/37 (92%) patients. For multigland disease, the glands were correctly located in 35/47 (74%) patients, with correct identification of the side in 35/47 (74%) and the quadrant in 36/47 (77%). The proposed high spatial and temporal resolution 4D-dynamic contrast-enhanced MR imaging provides excellent diagnostic performance for preoperative localization in primary hyperparathyroidism, with correct gland localization of 92% for single-gland disease and 74% in multigland disease, superior to 4D-CT studies.
Highlights
BACKGROUND AND PURPOSEOur aim was to test the hypothesis that our recently introduced 4D–dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation
ABBREVIATIONS: CAIPIRINHA 1⁄4 controlled aliasing in parallel imaging results in higher acceleration; DCE 1⁄4 dynamic contrast-enhanced; MGD 1⁄4 multigland disease; PHPT 1⁄4 primary hyperparathyroidism; PTA 1⁄4 single parathyroid adenoma; PTH 1⁄4 parathyroid hormone; SGD 1⁄4 single-gland disease; time-resolved imaging of contrast kinetics (TRICKS) 1⁄4 timeresolved imaging of contrast kinetics; Time-resolved imaging with stochastic trajectories (TWIST) 1⁄4 time-resolved imaging with stochastic trajectories
Primary hyperthyroidism (PHPT) causes overproduction of the parathyroid hormone (PTH) leading to hypercalcemia and is the most common parathyroid disease. It is caused by single parathyroid adenoma (PTA) in 80%–90%,1 multigland disease (MGD) in 5%–15%, and carcinoma in,1%
Summary
Our aim was to test the hypothesis that our recently introduced 4D–dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation
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