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Diagnostic Performance and Inter-Observer Agreement of 4-Dimensional Computed Tomography Parathyroid Scans in Patients with Primary and Secondary Hyperparathyroidism
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作者 Bundhit Tantiwongkosi Frank R. Miller +6 位作者 Viet D. Nguyen Kathleen E. Hands Boyce B. Oliver Alfredo A. Santillan Wilson B. Altmeyer Achint K. Singh Fang Yu 《Open Journal of Radiology》 2019年第1期82-91,共10页
Background: 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 robus... Background: 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. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: 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. Fleiss’ kappa was used to assess the inter-observer agreement. Results: 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. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement. 展开更多
关键词 computed tomography PARATHYROID 4-dimensional HYPERPARATHYROIDISM
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