Incidental detection of parathyroid adenomas on chest CT before clinical presentation of hyperparathyroidism

IF 3.8 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Academic Radiology Pub Date : 2025-03-01 DOI:10.1016/j.acra.2024.09.031

Raquelle El Alam , Mark M. Hammer , Rachna Madan

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引用次数: 0

Abstract

Rationale and Objectives

To evaluate whether parathyroid adenomas can be detected by thoracic radiologists on routine chest CT.

Materials/Methods

This retrospective study included patients with hyperparathyroidism evaluated by parathyroid scans and a control group with normal calcium. All had enhanced chest CT within 36 months prior to parathyroid imaging. Chest CTs were reviewed by 3 blinded thoracic radiologists. We report diagnostic accuracy for all positive findings and findings > 8 mm.

Results

Our sample comprised 126 patients, 63 with confirmed hyperparathyroidism and 63 control patients; 6 parathyroid cases were excluded for being out of the field of view. Readers 1, 2, and 3 had sensitivity of 95%, 60%, and 35%, and specificity of 88%, 89%, and 97%, respectively. Specificity increased to 95%, 97%, and 98% when considering only findings larger than 8 mm. Review of false negative studies for reader 1 revealed 3 parathyroid adenomas visualized in retrospect. Review of the 7 false positive studies for reader 1 revealed candidate lesions in all of them attributed to exophytic thyroid nodules or lymph nodes. 90%, 67%, and 40% of the parathyroid adenoma patients had at least 1, 2, and 3 complications respectively. Most prevalent complications were nephrolithiasis (48%) and osteopenia (46%).

Conclusions

Routine contrast-enhanced chest CT can detect the majority of parathyroid adenomas with high specificity.

Clinical Relevance/Application

Increasing awareness of parathyroid adenomas by chest radiologists allow for detection of enlarged parathyroid glands, diagnosing hyperparathyroidism before clinical presentation.

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在甲状旁腺功能亢进症临床表现之前，胸部 CT 意外发现甲状旁腺腺瘤。

理论依据和目的：评估胸部放射科医生能否通过常规胸部 CT 发现甲状旁腺腺瘤：这项回顾性研究包括通过甲状旁腺扫描评估的甲状旁腺功能亢进症患者和血钙正常的对照组。所有患者均在甲状旁腺成像前 36 个月内接受过增强胸部 CT 检查。胸部 CT 由 3 位盲胸科放射科医生进行审查。我们报告了所有阳性结果和大于 8 毫米结果的诊断准确性：我们的样本包括 126 例患者，其中 63 例确诊为甲状旁腺功能亢进，63 例为对照组患者；6 例甲状旁腺病例因超出视野而被排除。阅读器 1、2 和 3 的灵敏度分别为 95%、60% 和 35%，特异性分别为 88%、89% 和 97%。如果只考虑大于 8 毫米的检查结果，特异性则增至 95%、97% 和 98%。对读者1的假阴性研究进行复查后发现，有3个甲状旁腺腺瘤是在回顾性检查中发现的。对读者 1 的 7 项假阳性研究进行复查后发现，所有候选病变都是甲状腺外生结节或淋巴结。分别有90%、67%和40%的甲状旁腺腺瘤患者出现至少1、2和3种并发症。最常见的并发症是肾结石（48%）和骨质疏松症（46%）：常规造影剂增强胸部CT可检测出大多数甲状旁腺腺瘤，且特异性高：临床相关性/应用：胸部放射科医生对甲状旁腺腺瘤的认识不断提高，这有助于发现肿大的甲状旁腺，在临床表现前诊断甲状旁腺功能亢进症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Academic Radiology 医学-核医学

CiteScore

7.60

自引率

10.40%

发文量

432

审稿时长

18 days

期刊介绍： Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.