Preoperative imaging for hyperparathyroidism often takes upper parathyroid adenomas for lower adenomas
Annick Van den Bruel, Jacqueline Bijnens, Helena Van Haecke, Vincent Vander Poorten, Catherine Dick, Tom Vauterin, Frank De Geeter
Abstract
Abstract We retrospectively evaluated how accurately preoperative imaging localizes parathyroid adenoma in superior versus inferior parathyroids. Over 6 years, 104 patients with primary hyperparathyroidism underwent parathyroid surgery in a single centre. Of these, 103 underwent ultrasound, 97 [ 99m Tc]pertechnetate/MIBI SPECT/CT and 30 [ 18 F]fluorocholine (FCH) PET/CT. One patient with a unilateral double adenoma was excluded from the analysis. Surgical findings with histopathologic confirmation of adenoma were used as the standard. Ultrasound misjudged 5 of 48 detected lower adenomas as upper, but 14 of 29 upper adenomas as lower (error rate 10 vs 48%, p = 0.0002). The corresponding error rates for [ 99m Tc]pertechnetate/MIBI SPECT/CT were 3 versus 55% (p = 0.000014), and for [ 18 F]FCH PET/CT 17 versus 36% (p = 0.26). Our results suggest that about half of the superior parathyroid adenomas which are detected, are erroneously assigned to the inferior position by both ultrasound and SPECT/CT imaging whereas the opposite mistake is significantly less frequent with ultrasound and SPECT/CT.