Localization Strategy Prior to Radiofrequency Ablation for Primary and Secondary Hyperparathyroidism

Chih-Ying Lee; Yen-Hsiang Chang; Pi-Ling Chiang; Cheng-Kang Wang; An-Ni Lin; Chi-Cheng Chen; Yi-Fan Chen; Shun-Yu Chi; Fong-Fu Chou; Wei-Che Lin

doi:10.3390/biomedicines11030672

Localization Strategy Prior to Radiofrequency Ablation for Primary and Secondary Hyperparathyroidism

Biomedicines. 2023 Feb 23;11(3):672. doi: 10.3390/biomedicines11030672.

Authors

Affiliations

¹ Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
² Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
³ Departments of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.

Abstract

Objective: Preoperative localization in patients with primary or secondary hyperparathyroidism before radiofrequency ablation (RFA) is crucial. There is currently a lack of consensus regarding imaging protocol. Evaluating the diagnostic performance of ultrasound, four-dimensional computed tomography (4D-CT), and technetium 99m-sestamibi single-photon-emission-computed tomography/computed tomography (SPECT/CT) is necessary for RFA of hyperparathyroidism.

Methods: This retrospective study recruited patients with primary or secondary hyperparathyroidism who underwent ultrasound, 4D-CT, and SPECT/CT before RFA at a single institution. The sensitivity, accuracy, and receiver operating characteristic curve analysis were used to evaluate the diagnostic performance of the imaging modalities.

Results: A total of 33 patients underwent RFA for hyperparathyroidism (8 patients with primary hyperparathyroidism, 25 patients with secondary hyperparathyroidism). Ultrasound had the highest sensitivity (0.953) and accuracy (0.943), while 4D-CT had higher sensitivity and accuracy than SPECT/CT (sensitivity/accuracy, 4D-CT vs. SPECT/CT: 0.929/0.920 vs. 0.741/0.716). Combined ultrasound with 4D-CT and the three combined modalities achieved equivalent, and the highest, diagnostic performance (sensitivity 1.000, accuracy 0.989). The lesion length and volume were important predictors of the diagnostic performance of 4D-CT and SPECT/CT (area under curve of length in 4D-CT/volume in 4D-CT/length in SPECT/volume in SPECT: 0.895/0.834/0.767/0.761).

Conclusion: Combined ultrasound with 4D-CT provides optimal preoperative localization prior to RFA in patients with primary or secondary hyperparathyroidism. The length and volume of parathyroid lesions are determinative of the diagnostic performance of 4D-CT and SPECT/CT.

Keywords: four-dimensional computed tomography; hyperparathyroidism; localization strategy; primary hyperparathyroidism; radiofrequency ablation; secondary hyperparathyroidism; technetium 99m-sestamibi single-photon-emission-computed tomography/computed tomography; ultrasound.

Grants and funding

This research received no external funding.