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Review
. 2021 Jul 31;5(10):bvab132.
doi: 10.1210/jendso/bvab132. eCollection 2021 Oct 1.

High-frequency Multiphase 4DCT for the Detection of Parathyroid Adenomas: A Pictorial Essay

Steven Raeymaeckers  1 , Yannick De Brucker  1 , Maurizio Tosi  2 , Nico Buls  1 , Johan De Mey  2
Affiliations
Review

High-frequency Multiphase 4DCT for the Detection of Parathyroid Adenomas: A Pictorial Essay

Steven Raeymaeckers et al. J Endocr Soc. .

Abstract

4-Dimensional computed tomography (4DCT) for the detection of (an) enlarged parathyroid(s) is a commonly performed examination in the management of primary hyperparathyroidism. In our center, we introduced a high-frequency multiphase 4DCT protocol obtaining 16 phases, including 11 different arterial phases. Exposure to this multiphase 4DCT technique is similar to that for classic helical 4DCT. In this pictorial essay we reconstructed our multiphase 4DCT series in the manner of a classic helical 4DCT and compare both techniques. We illustrate how multiphase 4DCT may aid in the detection of parathyroid adenomas. We found 17 out of 19 lesions demonstrating a type A pattern of enhancement, therefore suggesting this pattern could be more prevalent than previously thought. Some parathyroid adenomas may be mistaken for enlarged lymph nodes using classic 4DCT whereas high-frequency multiphase 4DCT can detect a temporary rise in enhancement, thus suggesting the lesions in question to be of parathyroid origin. Smaller lesions may prove more obvious as the difference in enhancement between parathyroid and thyroid can become more prominent.

Key point: Using high-frequency multiphase 4DCT an arterial phase with maximum enhancement of parathyroid tissue can be defined. This phase may aid in the detection of parathyroid adenomas.

Keywords: 4DCT; Primary hyperparathyroidism; multiphase scanning; parathyroid adenoma.

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Figures

Figure 1.
Figure 1.
(A) NECT; (B) 24 seconds after contrast; (C) 28 seconds after contrast; (D) 60 seconds after contrast. Superior right-sided parathyroid adenoma. Contrast wash-in, no wash-out effect.
Figure 2.
Figure 2.
(A) NECT; (B) 24 seconds after contrast; (C) 26 seconds after contrast; (D) 60 seconds after contrast. Inferior left-sided parathyroid adenoma. Contrast wash-in and wash-out.
Figure 3.
Figure 3.
(A) NECT; (B) 24 seconds after contrast; (C) 32 seconds after contrast; (D) 60 seconds after contrast. Superior right-sided parathyroid adenoma. Contrast wash-in, no wash-out effect.
Figure 4.
Figure 4.
(A) NECT; (B) 24 seconds after contrast; (C) 30 seconds after contrast; (D) 60 seconds after contrast. Superior left-sided parathyroid adenoma. Contrast wash-in unclear at 24 seconds but evident at 30 seconds after contrast administration. Contrast wash-out.
Figure 5.
Figure 5.
(A) NECT; (B) 24 seconds after contrast; (C) 40 seconds after contrast; (D) 60 seconds after contrast. Ectopic retropharyngeal situated parathyroid adenoma. No contrast wash-in at 24 seconds, discrete wash-in at 40 seconds after contrast administration. Contrast wash-out.
Figure 6.
Figure 6.
(A) NECT; (B) 24 seconds after contrast; (C) 40 seconds after contrast; (D) 60 seconds after contrast. Inferior left-sided parathyroid adenoma. No enhancement at 24 seconds, discrete enhancement at 40 seconds after contrast administration but no wash-in effect. Contrast wash-out.
Figure 7.
Figure 7.
(A) NECT; (B) 24 seconds after contrast; (C) 38 seconds after contrast; (D) 60 seconds after contrast.
See this image and copyright information in PMC

References

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