S-Space College of Medicine/School of Medicine (의과대학/대학원) Dept. of Medicine (의학과) Theses (Master's Degree_의학과)
Comparison of 4D CT, USG, and 99mTc Sestamibi SPECT/CT in Localizing Single-Gland Primary Hyperparathyroidism
단일 병변 일차성 부갑상선 항진증의 정위를 위한 4D CT, USG, 99mTc Sestamibi SPECT/CT 비교
- 의과대학 의학과
- Issue Date
- 서울대학교 대학원
- 학위논문 (석사)-- 서울대학교 대학원 : 의학과, 2014. 2. 정성은.
- Introduction: Four-dimensional computed tomography (4D CT) provides surgeons with anatomical and functional information about parathyroid glands for minimally invasive parathyroidectomy (MIP). The purpose of this study was to evaluate the usefulness of 4D CT for localizing single-gland primary hyperparathyroidism (HPT).
Methods: Twenty-four patients were selected, who underwent focused parathyroidectomy for single gland primary HPT between June 2011 and February 2013. Three imaging modalities of ultrasonography (US), 99mTc sestamibi scanning with single positron emission computed tomography/CT (SeS), and 4D CT, were performed for each patient. Data were reviewed retrospectively and imaging modalities were compared in terms of sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Associations between correct 4D CT localization of abnormal parathyroid glands and demographic, clinical, and pathological characteristics were assessed.
Results: Compared to US, 4D CT was more sensitive (91.7% vs. 62.5%
p=0.015) and specific (97.2% vs. 88.9%
p=0.05), and had higher positive predictive value (91.7% vs. 65.2%
p<0.001), negative predictive value (97.2% vs. 87.7%
p=0.021), and accuracy (95.8% vs. 82.3%
p=0.005). 4D CT did not differ significantly from SeS in terms of any measure. However, in 6/24 (25%) patients, where neither US nor SeS yielded convincing data, 4D CT provided correct localization for MIP. 4D CT localization correlated with maximal diameter (p=0.004) and volume (p=0.002) of parathyroid glands.
Conclusions: 4D CT is a valuable imaging technique for detecting lesions in primary HPT. Compared to conventional imaging, including SeS, its sensitivity is similar or higher
it is also more specific than either US or SeS.