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01-11-2018 | Head and Neck

Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans

Authors: Renato Argirò, Daniele Diacinti, Beatrice Sacconi, Angelo Iannarelli, Davide Diacinti, Cristiana Cipriani, Daniela Pisani, Elisabetta Romagnoli, Marco Biffoni, Cira Di Gioia, Jessica Pepe, Mario Bezzi, Claudio Letizia, Salvatore Minisola, Carlo Catalano

Published in: European Radiology | Issue 11/2018

Abstract

Objectives

To evaluate the diagnostic performance of 3TMRI in comparison with ultrasound (US) and 99mTc-sestamibi scan for presurgical localisation of parathyroid adenomas (PTAs) in patients with primary hyperparathyroidism (PHPT).

Methods

Fifty-seven patients affected by PHPT were prospectively enrolled and underwent US, 99mTc-sestamibi and 3TMRI. T2-weighted and post-contrast T1-weighted Iterative decomposition of water and fat with Echo Asymmetry and Least squares estimation (IDEAL) sequences were acquired. Diagnostic performance of US, 99mTc-sestamibi and MRI in localising PTAs to correct quadrant were compared according to surgical and pathological findings.

Results

According to surgical findings, US correctly localised 41/46 PTAs (sensitivity of 89.1%; specificity 97.5%; PPV 93.1% and NPV 95.6%); 99mTc-sestamibi correctly localised 38/46 PTAs (sensitivity 83.6%, specificity 98.3%, PPV 95% and NPV 93.7%). US and 99mTc-sestamibi combined had a sensitivity of 93.4% (43/46 PTAs), specificity of 98.3%, PPV 95% and NPV 98.3%. MRI correctly localised 45/46 PTAs (sensitivity 97.8%; specificity 97.5%; PPV 93.7% and NPV 99.2%). MRI was able to detect six adenomas missed by 99mTc-sestamibi and two adenomas missed by US. MRI and US were able to detect all enlarged parathyroid glands in patients with multiglandular disease. MRI identified six of seven ectopic adenomas.

Conclusions

Our study demonstrated high diagnostic performance of 3T MRI in the preoperative PTAs quadrant localisation, as well as in patients with multiglandular disease and ectopic PTAs. MRI may be preferred to adequately select patient candidates for minimally invasive parathyroidectomy (MIP).

Key Points

• PTA(s) quadrant localisation by 3TMRI was more accurate than US+99mTc-sestamibi.

• MRI identified all enlarged glands in multiglandular disease similarly to US.

• MRI identified 6/7 ectopic PTAs similarly to 99mTc-sestamibi.

• Presurgical PTA(s) localisation by 3TMRI select the optimal candidates for MIP.

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Title: Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans
Authors: Renato Argirò
Daniele Diacinti
Beatrice Sacconi
Angelo Iannarelli
Davide Diacinti
Cristiana Cipriani
Daniela Pisani
Elisabetta Romagnoli
Marco Biffoni
Cira Di Gioia
Jessica Pepe
Mario Bezzi
Claudio Letizia
Salvatore Minisola
Carlo Catalano
Publication date: 01-11-2018
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 11/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-018-5437-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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