Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 May 1;148(5):448-456.
doi: 10.1001/jamaoto.2022.0271.

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Nrusheel Kattar  1 , Matthew Migneron  2 , Michael S Debakey  2 , Muhib Haidari  2 , Anna M Pou  1 , Edward D McCoul  1   2   3
Affiliations
Meta-Analysis

Advanced Computed Tomographic Localization Techniques for Primary Hyperparathyroidism: A Systematic Review and Meta-analysis

Nrusheel Kattar et al. JAMA Otolaryngol Head Neck Surg. .

Abstract

Importance: Emerging computed tomographic (CT) imaging techniques for the localization of primary hyperparathyroidism (PHPT) may be superior to the current imaging standard, thus necessitating a critical review and pooling of available evidence.

Objective: Primary hyperparathyroidism requires accurate imaging to guide definitive surgical management. Advanced techniques including 4-dimensional computed tomographic (4D-CT) scan have been investigated over the past decade. We sought to evaluate the efficacy of these emerging imaging techniques through pooled analysis of the existing evidence.

Data sources: PubMed, Embase, and Web of Science databases were queried for original English articles without any restrictions on date.

Study selection: We included comparative observational studies but excluded animal studies, case reports, and case series. Overall, 353 abstracts were screened independently by 2 investigators along with a third reviewer to resolve conflicts. A total of 26 full-text articles were included in this review.

Data extraction and synthesis: This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Data was independently extracted by 2 investigators and subsequently pooled into a meta-analysis using a random-effects model.

Main outcomes and measures: Measures of imaging diagnostic performance such as sensitivity, specificity, positive predictive value, and negative predictive value were the primary outcomes of interest.

Results: Overall, of 34 articles screened, 26 met criteria for qualitative synthesis, and 23 of these were appropriate for meta-analysis. Of the 26 studies included, there were 5845 patients, of which 4176 were women (79.2%). The average of mean ages reported in 23 studies was 60.9 years. Meta-analysis in all patients with PHPT revealed pooled sensitivity that was greater with 4D-CT (81%; 95% CI, 77%-84%; I2 = 88%) compared with the current first-line modality of sestamibi-single-photon emission CT (SPECT/CT) (65%; 95% CI, 59%-70%; I2 = 93%). For patients with recurrent PHPT requiring reoperation, 4D-CT pooled sensitivity was 81% (95% CI, 64%-98%; I2 = 93%) in contrast to 53% (95% CI, 35%-71%; I2 = 81%) for sestamibi-SPECT/CT. The overall quality of the 26 studies was moderate with a median (range) Methodological Index for Nonrandomized Studies score for all included studies of 15.5 (13-19).

Conclusions and relevance: The findings of this systematic review and with meta-analyses of numerous studies from the past decade suggest that the 4D-CT can be more sensitive and specific than sestamibi-SPECT/CT in localizing PHPT. More research is needed to determine the clinical significance of this improvement in localization.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr McCoul reported personal fees from Stryker outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. PRISMA Flow Diagram of Systematic Review of Advanced CT Localization Techniques for Patients With Primary Hyperparathyroidism
CT Indicates computed tomography.
Figure 2.
Figure 2.. Forest Plot of Meta-analysis of Pooled Sensitivity in Systematic Review of Advanced CT Localization Techniques for Patients With Primary Hyperparathyroidism
Diamond, overall effect estimates; square, point estimate of the study; black line, 95% CI.
Figure 3.
Figure 3.. Forest Plot of Meta-analysis of Pooled Specificity in Systematic Review of Advanced CT Localization Techniques for Patients With Primary Hyperparathyroidism
Diamond, overall effect estimates; square, point estimate of the study; black line, 95% CI.
Figure 4.
Figure 4.. Forest Plot of Meta-analysis of Pooled Sensitivity for Reoperative Patients in Systematic Review of Advanced CT Localization Techniques for Patients With Primary Hyperparathyroidism
Diamond, overall effect estimates; square, point estimate of the study; black line, 95% CI.
See this image and copyright information in PMC

Comment in

References

    1. Wermers RA, Khosla S, Atkinson EJ, et al. . Incidence of primary hyperparathyroidism in Rochester, Minnesota, 1993-2001: an update on the changing epidemiology of the disease. J Bone Miner Res. 2006;21(1):171-177. doi:10.1359/JBMR.050910 - DOI - PubMed
    1. Carlson D. Parathyroid pathology: hyperparathyroidism and parathyroid tumors. Arch Pathol Lab Med. 2010;134(11):1639-1644. doi:10.5858/2009-0578-CCR.1 - DOI - PubMed
    1. Chazen JL, Gupta A, Dunning A, Phillips CD. Diagnostic accuracy of 4D-CT for parathyroid adenomas and hyperplasia. AJNR Am J Neuroradiol. 2012;33(3):429-433. doi:10.3174/ajnr.A2805 - DOI - PMC - PubMed
    1. Hoang JK, Sung WK, Bahl M, Phillips CD. How to perform parathyroid 4D CT: tips and traps for technique and interpretation. Radiology. 2014;270(1):15-24. doi:10.1148/radiol.13122661 - DOI - PubMed
    1. Roskies M, Liu X, Hier MP, et al. . 3-phase dual-energy CT scan as a feasible salvage imaging modality for the identification of non-localizing parathyroid adenomas: a prospective study. J Otolaryngol Head Neck Surg. 2015;44:44. doi:10.1186/s40463-015-0098-y - DOI - PMC - PubMed

Substances