Can the Extent of Surgery Be Narrowed by Using 4d-ct in Parathyroid Adenomas With Unclear Localization?
Year: 2026
Type: article
Study design: Observational Study
Abstract: Objective: Accurate preoperative localisation is crucial for the surgical management of primary hyperparathyroidism (pHPT). When first-line imaging modalities such as ultrasonography (USG) and Sestamibi SPECT/CT fail to identify the hyperfunctioning gland, four-dimensional computed tomography (4D-CT) may offer additional diagnostic benefit.Materials and Methods: This retrospective study reviewed 370 parathyroidectomy cases and included adults with primary hyperparathyroidism who underwent 4D-CT after ultrasonography and technetium-99m sestamibi SPECT/CT failed to localise the parathyroid adenoma. Patients with secondary or tertiary hyperparathyroidism were excluded. Demographic and biochemical data, intraoperative findings, and histopathology results were analysed. A standardised three-phase 4D-CT protocol and intraoperative PTH monitoring were used, and the imaging results were correlated with surgical and pathological outcomes to determine diagnostic accuracy.Results: 4D-CT accurately localised parathyroid adenomas in 13 of 22 patients (59%), with a sensitivity of 68.4%, specificity of 33.3%, positive predictive value of 86.7%, negative predictive value of 14.3%, and overall diagnostic accuracy of 63.6%. Two patients had mediastinal ectopic adenomas, and the false-positive rate was 13.3%. Focused or unilateral neck exploration was feasible in 59% of patients, reducing surgical invasiveness. No major postoperative complications were observed.Conclusion: 4D-CT provides significant diagnostic and surgical value in patients with nonlocalized pHPT following inconclusive first-line imaging. Its high positive predictive value enables precise localisation and supports minimally invasive parathyroidectomy, improving operative precision and patient outcomes.
Institution: Sağlık Bilimleri Üniversitesi
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7220652276