%0 Journal Article
%T Diagnostic Performance and Inter-Observer Agreement of 4-Dimensional Computed Tomography Parathyroid Scans in Patients with Primary and Secondary Hyperparathyroidism
%A Bundhit Tantiwongkosi
%A Frank R. Miller
%A Viet D. Nguyen
%A Kathleen E. Hands
%A Boyce B. Oliver
%A Alfredo A. Santillan
%A Wilson B. Altmeyer
%A Achint K. Singh
%A Fang Yu
%J Open Journal of Radiology
%P 82-91
%@ 2164-3032
%D 2019
%I Scientific Research Publishing
%R 10.4236/ojrad.2019.91008
%X <em>Background:</em> 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.<em> Purpose: </em>To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. <em>Methods:</em> 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. FleissĄŻ kappa was used to assess the inter-observer agreement.<em> Results:</em> 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. FleissĄŻ kappa value is 5.6 (moderate inter-observer agreement). <em>Conclusion:</em> 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement.
%K Computed Tomography
%K Parathyroid
%K 4-Dimensional
%K Hyperparathyroidism
%U http://www.scirp.org/journal/PaperInformation.aspx?PaperID=91090