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Diagnostic Performance and Inter-Observer Agreement of 4-Dimensional Computed Tomography Parathyroid Scans in Patients with Primary and Secondary Hyperparathyroidism

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Document pages: 10 pages

Abstract: Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robust imaging method with high diagnostic accuracy, becoming increasingly popular among surgeons and radiologists. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: We analyzed patients with primary and secondary hyperparathyroidism who had intraoperative reports, pathology, parathyroid hormone levels, and preoperative 4D-CT. Histology, surgical findings, and decreased parathyroid hormone levels were used as gold standards. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95 confidence interval were calculated. Fleiss’ kappa was used to assess the inter-observer agreement. Results: Sixty-seven patients were included. Sixty-two patients had a single adenoma, and five patients had a multiple gland disease (adenomas or hyperplasia). A total of 72 glands were proven to have parathyroid adenomas or hyperplasia. The sensitivity, specificity, PPV, NPV and accuracy are 85 , 97 , 96 , 87 and 91 for lateralization and 76 , 96 , 85 , 92 and 90 for quadrant localization, respectively in single-gland disease. The sensitivity, specificity, PPV, NPV and accuracy are 88 , 100 , 100 , 50 and 90 for lateralization and 71 , 100 , 100 , 60 and 80 for quadrant localization respectively in multiple-gland disease. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement.

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