K. O. Memeh1, J. Palacios1, M. Guerrero1 1Banner- University Of Arizona Medical Center,Surgery,Tucson, AZ, USA
Introduction:
Accurate pre-operative image localization is useful in selecting minimally invasive parathyroidectomy in patients with primary hyperparathyroidism (PHPT). Sestamibi scan, ultrasound, compted tomography and conventional magnetic resonance imaging (MRI) has varying accuracy in localizing parathyroid adenoma. Our group has shown that 4D MRI is more accurate than conventional imaign in identifying single adenomas. In this study, we set out to determine if 4D-MRI is able to accuratley localize the quadrant (superior or inferior) of the adenoma.
Methods:
We analysed and matched the result of MRI parathyroid protocol of all patients who underwent parathyroidectomy for PHPT at the University Of Arizona Medical Center between Feb 2015 and May 2016 with the intra-operative findings. All resections were confirmed successful with adequate decrease in intraoperative PTH as defined by the Miami criteria.
Results:
A total of 26 patients with PHPT underwent pre-operative localization with 4D-MRI neck. 14 patients had single adenoma and 12 patients had multi- gland disease. MRI accurately distinguished single from multigland disease in 85% of cases. MRI accurately identifed single adenomas in 100% of patients. MRI was further able to identify the correct quadrant in all patients with single adenoma. However, MRI was only accurate 67% of the time in identifying multi-gland disease, but accurately idenified all (3) double adenoma’s.
Conclusion:
4D MRI accurately identified single and double adenomas in their respective quadrants. However, accuracy in multigland hyperplasia was lower. This study shows that 4D MRI is a usefule imaging modality in single and double gland disease.