Abstract
Patients with multigland primary hyperparathyroidism are at higher risk for missed lesions on imaging and failed parathyroidectomy. The purpose of this study was to prospectively validate the ability of previously derived predictive score systems, the composite multigland disease score, and the multiphase multidetector contrast-enhanced CT (4D-CT) composite multigland disease score, to identify patients with a high likelihood of multigland disease. This was a prospective study of 71 patients with primary hyperparathyroidism who underwent 4D-CT and successful parathyroidectomy. The size and number of lesions identified on 4D-CT, serum calcium levels, and parathyroid hormone levels were collected. A composite multigland disease score was calculated from 4D-CT imaging findings and the Wisconsin Index (the product of the serum calcium and parathyroid hormone levels). A 4D-CT multigland disease score was obtained by using the CT data alone. Twenty-eight patients with multigland disease were compared with 43 patients with single-gland disease. Patients with multigland disease had a significantly smaller lesion size (P < .01) and a higher likelihood of having either ≥2 or 0 lesions identified on 4D-CT (P < .01). Composite multigland disease scores of ≥4, ≥5, and 6 had specificities of 72%, 86%, and 100% for multigland disease, respectively. 4D-CT multigland disease scores of ≥3 and 4 had specificities of 74% and 88%. Predictive scoring systems based on 4D-CT data, with or without laboratory data, were able to identify a subgroup of patients with a high likelihood of multigland disease in a prospectively accrued population of patients with primary hyperparathyroidism. These scoring systems can aid in surgical planning.
Highlights
BACKGROUND AND PURPOSEPatients with multigland primary hyperparathyroidism are at higher risk for missed lesions on imaging and failed parathyroidectomy
Twenty-eight patients with multigland disease were compared with 43 patients with single-gland disease
Predictive scoring systems based on 4D-CT data, with or without laboratory data, were able to identify a subgroup of patients with a high likelihood of multigland disease in a prospectively accrued population of patients with primary hyperparathyroidism
Summary
Study Subjects Institutional review board approval was obtained for this study, which was performed with a waiver of informed consent and a waiver of Health Insurance Portability and Accountability Act authorization. The 4D-CT MGD score does not include the WIN and ranges from 0 to 4. Predictors of Multigland Disease 4D-CT imaging and biochemical predictors of MGD were originally proposed by Sepahdari et al on the basis of prior surgical literature.12,13 4D-CT imaging predictors were the number of lesions identified on the original radiology report and the size of the largest lesion (maximum diameter in any plane). A composite MGD score was derived from variables of lesion size on 4D-CT, the number of prospectively detected lesions on 4D-CT, and the WIN. A second scoring system, the 4D-CT MGD score, was based only on the 4D-CT imaging variables of lesion size and the number of prospectively detected lesions on 4D-CT. There were no statistically significant differences between the SGD and MGD groups with regard to age and sex
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