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Case Reports
. 2013 Aug;34(8):E91-3.
doi: 10.3174/ajnr.A3657. Epub 2013 Jun 20.

Dual-energy 4-phase CT scan in primary hyperparathyroidism

D Lau, H Yang, P L Kei
Case Reports

Dual-energy 4-phase CT scan in primary hyperparathyroidism

D Lau et al. AJNR Am J Neuroradiol. 2013 Aug.
No abstract available

PubMed Disclaimer

Figures

Fig 1.
Fig 1.
CT examination of the patient by using our modified 4D CT protocol shows a 6 × 3 mm nodular parathyroid adenoma (arrows) lying in the superomedial aspect, posterior to the left thyroid lobe in both sagittal (A) and axial (B) sections. The iodine overlay image (acquired by using dual-energy CT in the venous phase), also obtained by using this protocol, allows the measurement of iodine concentration in the tissues, to differentiate between the parathyroid adenoma and surrounding thyroid tissues (C). Directed parathyroidectomy and histopathologic examination, thereafter, confirmed the presence of a parathyroid adenoma.
Fig 2.
Fig 2.
Modified 4D CT by using our suggested protocol demonstrates the enhancement characteristics of a hyperplastic parathyroid adenoma (region of interest 1) and an adjacent soft-tissue structure (ie, a normal-functioning thyroid gland) (region of interest 2). Contrast-enhancement analysis on the parathyroid adenoma shows an attenuation value of 36.1 HU on the virtual noncontrast scan (A), which rapidly enhanced to 175.5 HU in the arterial phase (B), and immediately decreased to 100.3 HU in the dual-energy venous phase (C) and 75.1 HU in the delayed (D) image. The parathyroid adenoma can be easily distinguished from the surrounding soft tissues on the basis of its characteristic “rapid contrast uptake and washout” feature.
Fig 3.
Fig 3.
Attenuation plots show the characteristic dynamic contrast-enhancement pattern of the parathyroid adenoma (ie, rapid contrast uptake and washout, (A) and a normal-functioning right thyroid gland (B) measured from the same scans obtained from the patient diagnosed with PHPT by using our modified 4D CT protocol. The mean Hounsfield unit attenuations of the imaged structures in the VNC (reconstructed from the dual-energy venous [DE-venous]), arterial (by using bolus tracking), DE-venous (55 seconds), and delayed (85 seconds) phases were measured by using region-of-interest analysis as shown in Fig 2.
See this image and copyright information in PMC

References

    1. Gafton AR, Glastonbury CM, Eastwood JD, et al. . Parathyroid lesions: characterization with dual-phase arterial and venous enhanced CT of the neck. AJNR Am J Neuroradiol 2012;33:949–52 - PMC - PubMed
    1. Tawfik AM, Kerl JM, Razek AA, et al. . Image quality and radiation dose of dual-energy CT of the head and neck compared with a standard 120-kVp acquisition. AJNR Am J Neuroradiol 2011;32:1994–99 - PMC - PubMed
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