A quantitative enhancement characterization of hyperfunctioning parathyroid lesions on four-dimensional CT scans
Keywords:
: Hyperfunctioning parathyroid lesion, 4DCT, multidetector computed tomographyAbstract
Background: Approximately 20.0% of hyperfunctioning parathyroid lesions do not exhibit typical enhancement characteristics on Four-dimensional computed tomography (4DCT). The two main mimics of hyperfunctioning parathyroid lesions are thyroid tissue and lymph nodes.
Objective: The study aimed to characterize enhancement patterns of hyperfunctioning parathyroid lesions on four-dimensional computed tomography (4DCT) and to differentiate hyperfunctioning parathyroid lesions from thyroid gland and lymph node.
Methods: This retrospective study included analysis of 47 hyperfunctioning parathyroid lesions either pathologically proven or uptake on Tc99m-sestamibi SPECT-CT. The attenuation of hyperfunctioning parathyroid lesions, thyroid glands, lymph nodes and muscles at non-contrast, arterial phase and delayed phase were measured. The discriminant function and optimal cut-off value were evaluated using receiver operating characteristic (ROC) curve analysis. Subgroup analysis between all included lesions and exclusively pathologically proven lesions were performed.
Results: Hyperfunctioning parathyroid lesions showed significantly lower attenuation than thyroid glands in all phases (P < 0.001) and significantly higher arterial uptake percentage, delayed uptake percentage and washout percentage than thyroid glands. The area under the ROC curve was greatest in the non-contrast phase, with an optimal cut-off value of 71.7 hounsfield units (HU) in both subgroups. Hyperfunctioning parathyroid lesions showed significantly higher attenuation than lymph nodes in the arterial and delayed phases and significantly higher arterial uptake and washout percentage than lymph nodes. The area under the ROC curve was greatest in the arterial phase, with an optimal cut-off value of
107.1 HU in both subgroups.
Conclusion: The best single phase to differentiate hyperfunctioning parathyroid lesions from thyroid glands and lymph nodes were non-contrast and arterial phases, respectively. Arterial uptake percentage was the best discriminator between hyperfunctioning parathyroid lesions from thyroid glands and lymph nodes, as hyperfunctioning parathyroid lesions showed a significantly higher uptake percentage.
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