Author(s)

Bundhit Tantiwongkosi^1,2, Frank R. Miller², Viet D. Nguyen¹, Kathleen E. Hands³, Boyce B. Oliver⁴, Alfredo A. Santillan⁵, Wilson B. Altmeyer¹, Achint K. Singh¹, Fang Yu⁶

¹Radiology Department, University of Texas Health San Antonio, San Antonio, TX, USA.
²Otolaryngology, Head Neck Surgery Department, University of Texas Health San Antonio, San Antonio, TX, USA.
³Thyroid and Endocrine Center of South Texas, San Antonio, TX, USA.
⁴Surgical Oncology Department, University of Texas Health San Antonio, San Antonio, TX, USA.
⁵Surgical Oncology Department, Texas Oncology, San Antonio, TX, USA.
⁶Radiology Department, University of Texas Southwestern, Dallas, TX, USA.

Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robust imaging method with high diagnostic accuracy, becoming increasingly popular among surgeons and radiologists. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: We analyzed patients with primary and secondary hyperparathyroidism who had intraoperative reports, pathology, parathyroid hormone levels, and preoperative 4D-CT. Histology, surgical findings, and decreased parathyroid hormone levels were used as gold standards. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated. Fleiss’ kappa was used to assess the inter-observer agreement. Results: Sixty-seven patients were included. Sixty-two patients had a single adenoma, and five patients had a multiple gland disease (adenomas or hyperplasia). A total of 72 glands were proven to have parathyroid adenomas or hyperplasia. The sensitivity, specificity, PPV, NPV and accuracy are 85%, 97%, 96%, 87% and 91% for lateralization and 76%, 96%, 85%, 92% and 90% for quadrant localization, respectively in single-gland disease. The sensitivity, specificity, PPV, NPV and accuracy are 88%, 100%, 100%, 50% and 90% for lateralization and 71%, 100%, 100%, 60% and 80% for quadrant localization respectively in multiple-gland disease. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement.

Computed Tomography, Parathyroid, 4-Dimensional, Hyperparathyroidism

Tantiwongkosi, B. , Miller, F. , Nguyen, V. , Hands, K. , Oliver, B. , Santillan, A. , Altmeyer, W. , Singh, A. and Yu, F. (2019) Diagnostic Performance and Inter-Observer Agreement of 4-Dimensional Computed Tomography Parathyroid Scans in Patients with Primary and Secondary Hyperparathyroidism. Open Journal of Radiology, 9, 82-91. doi: 10.4236/ojrad.2019.91008.