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. 2023 Jun 9;15(6):e40166.
doi: 10.7759/cureus.40166. eCollection 2023 Jun.

An Assessment of Enhancement Patterns in Abnormal Parathyroid Glands on Three-Phase CT Imaging

Joseph Vance-Daniel  1 , Oliver Curwen  1 , Lauren Stroud  1 , Visvalingham Gnanananthan  2 , Kashif Burney  2 , Karim Jamal  3
Affiliations

An Assessment of Enhancement Patterns in Abnormal Parathyroid Glands on Three-Phase CT Imaging

Joseph Vance-Daniel et al. Cureus. .

Abstract

Background Four-dimensional computed tomography (4DCT) is increasingly used in the investigation of primary hyperparathyroidism. The objective of this study was to identify and analyse the usefulness of different enhancement patterns on 4DCT to improve its sensitivity. Methodology Retrospective data were collected on 100 glands. A consultant head and neck radiologist measured the Hounsfield units (HU) of the parathyroid gland and surrounding normal thyroid tissue in the pre-contrast, arterial and venous phases. Each gland was grouped according to the enhancement pattern, and the percentage change in HU was also calculated between the three phases. Results Thirty-five parathyroid glands demonstrated enhancement higher than the thyroid gland in the arterial phase and lower in the delayed phase and were placed into group A. Four parathyroid glands demonstrated enhancement higher than the thyroid gland in the arterial phase and also higher in the delayed phase and were placed into group B. Fifty-nine parathyroid glands demonstrated enhancement lower than the thyroid gland in the arterial phase and also lower in the delayed phase and were placed into group C. Two parathyroid glands demonstrated enhancement lower than the thyroid gland in the arterial phase and higher in the delayed phase and were placed into group D. Conclusions This study demonstrated that the classically described enhancement pattern of the parathyroid gland is not always present or the most frequent, thereby showing that the enhancement pattern cannot be relied upon in isolation. Instead, a thorough understanding of anatomy, embryology and possible ectopic gland locations is essential.

Keywords: atypical parathyroid; ectopic parathyroid; four-dimensional computed tomography (4dct); head and neck and endocrine; parathyroid disease.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Allocation of subgroups by enhancement patterns.
Figure credit: All authors.
Figure 2
Figure 2. Graphical representation of the mean enhancement patterns of each group.
The pre-contrast phase is at 0 seconds, the arterial phase at 25 seconds and the venous phase at 80 seconds.
See this image and copyright information in PMC

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