Comparative Effectiveness of MRI, 4D-CT and Ultrasonography in Patients with Secondary Hyperparathyroidism.

IF 2.3 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES Therapeutics and Clinical Risk Management Pub Date : 2023-01-01 DOI:10.2147/TCRM.S379814

Jiaoping Mi, Yijie Fang, Jianzhong Xian, Guojie Wang, Yuanqing Guo, Haiyu Hong, Mengshi Chi, Yong-Fang Li, Peng He, Jiebing Gao, Wei Liao

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Abstract

Objective: Accurate preoperative localization of abnormal parathyroid glands is crucial for successful surgical management of secondary hyperparathyroidism (SHPT). This study was conducted to compare the effectiveness of preoperative MRI, 4D-CT, and ultrasonography (US) in localizing parathyroid lesions in patients with SHPT.

Methods: We performed a retrospective review of prospectively collected data from a tertiary-care hospital and identified 52 patients who received preoperative MRI and/or 4D-CT and/or US and/or ^99mTc-MIBI and subsequently underwent surgery for SHPT between May 2013 and March 2020. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of each imaging modality to accurately detect enlarged parathyroid glands were determined using histopathology as the criterion standard with confirmation using the postoperative biochemical response.

Results: A total of 198 lesions were identified intraoperatively among the 52 patients included in this investigation. MRI outperformed 4D-CT and US in terms of sensitivity (P < 0.01), specificity (P = 0.455), PPV (P = 0.753), and NPV (P = 0.185). The sensitivity and specificity for MRI, 4D-CT, and US were 90.91%, 88.95%, and 66.23% and 58.33%, 63.64%, and 50.00%, respectively. The PPV of combined MRI and 4D-CT (96.52%) was the highest among the combined 2 modalities. The smallest diameter of the parathyroid gland precisely localized by MRI was 8×3 mm, 5×5 mm by 4D-CT, and 5×3 mm by US.

Conclusion: MRI has superior diagnostic performance compared with other modalities as a first-line imaging study for patients undergoing renal hyperparathyroidism, especially for ectopic or small parathyroid lesions. We suggest performing US first for diagnosis and then MRI to make a precise localization, and MRI proved to be very helpful in achieving a high success rate in the surgical treatment of renal hyperparathyroidism in our own experience.

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MRI、4D-CT及超声对继发性甲状旁腺功能亢进的疗效比较。

目的:术前准确定位异常甲状旁腺是继发性甲状旁腺功能亢进(SHPT)手术治疗成功的关键。本研究旨在比较术前MRI、4D-CT和超声(US)对SHPT患者甲状旁腺病变定位的有效性。方法:我们对一家三级医院前瞻性收集的数据进行了回顾性分析，并确定了2013年5月至2020年3月期间接受术前MRI和/或4D-CT和/或US和/或99mTc-MIBI并随后接受SHPT手术的52例患者。以组织病理学为标准确定各成像方式准确检测甲状旁腺肿大的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)，并用术后生化反应进行确认。结果:52例患者术中共发现198个病变。MRI在敏感性(P < 0.01)、特异性(P = 0.455)、PPV (P = 0.753)和NPV (P = 0.185)方面优于4D-CT和US。MRI、4D-CT、US的敏感性、特异性分别为90.91%、88.95%、66.23%、58.33%、63.64%、50.00%。MRI和4D-CT联合检查的PPV最高，为96.52%。MRI精确定位的甲状旁腺最小直径为8×3 mm, 4D-CT为5×5 mm, US为5×3 mm。结论:对于肾性甲状旁腺功能亢进患者，尤其是异位或小的甲状旁腺病变，MRI作为一线影像学检查具有优越的诊断价值。我们建议先做US诊断，再做MRI精确定位，根据我们的经验，MRI对肾性甲状旁腺功能亢进的手术治疗成功率很高。

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

4.80

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.