The polar vessel sign: insights from CT imaging analysis in Asian Indian primary hyperparathyroidism.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2024-10-19 DOI:10.1007/s12020-024-04076-9

Anima Sharma, Saba Samad Memon, Manjunath Goroshi, Shetteppa Goroshi, Virendra Patil, Padma Vikram Badhe, Hemangini Thakkar, Vijaya Sarathi, Aditya Phadte, Chethan Yami Channaiah, Manjiri Karlekar, Rohit Barnabas, Anurag Ranjan Lila, Tushar Bandgar

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Abstract

Purpose: Data on the polar vessel sign (enlarged feeding vessel terminating in parathyroid lesions) on four-dimensional computed tomography (4D-CT) is limited. We performed a retrospective analysis to determine the prevalence, predictors, and adjunctive utility of polar vessel sign in pre-operative 4D-CT of patients with primary hyperparathyroidism (PHPT).

Methods: One radiologist blinded to the patients' details reported the 4D-CT of eighty-four operated patients with histopathology-proven single-gland PHPT. Two protocols were used to obtain arterial-phase images: timed via bolus tracking (n = 41) or fixed at 20 s after contrast injection (n = 43).

Results: Seventy-one patients were symptomatic for PHPT, with median serum calcium 12.1 mg/dL. On the arterial phase of 4D-CT, 88.1% of lesions had the polar vessel sign, including 7/9 asymptomatic patients, 6/6 parathyroid carcinomas, and 3/4 ectopic(1:mediastinum, 2:thyro-thymic ligament). Predictors of polar vessel sign were maximum lesion dimension (2.2 vs. 1.4 cm; P = 0.03), solid-cystic CT morphology (47.3% vs. none; P = 0.004), and bolus tracking-timed arterial phase (55.4% vs. none; P = 0.001). Of these, bolus tracking improved the polar vessel's visualization (100% vs. 76.7%; P = 0.001) independent of lesion dimension and solid-cystic morphology. The latter two predicted polar vessel sign in images obtained at a fixed interval (20 s). A significantly lower proportion of bolus tracking-timed scans had lesion percentage arterial enhancement (PAE) < 128.9% (2/41 vs. 9/43; P = 0.04). Even with suboptimal PAE, the polar vessel helped identify 9/11 lesions.

Conclusion: The polar vessel sign demonstrated an additive role to PAE during CT reporting. Bolus tracking is valuable in optimizing vessel and tumor arterial enhancement and is easily incorporated into parathyroid 4D-CT protocol.

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极血管征：CT成像分析对亚洲印度原发性甲状旁腺功能亢进症的启示。

目的：有关四维计算机断层扫描（4D-CT）中极性血管征（终止于甲状旁腺病变的扩大进血管）的数据非常有限。我们进行了一项回顾性分析，以确定原发性甲状旁腺功能亢进症（PHPT）患者术前四维计算机断层扫描中极性血管征的发生率、预测因素和辅助作用：一位对患者详细情况保密的放射科医生报告了84例经组织病理学证实的单腺PHPT手术患者的4D-CT结果。采用两种方案获取动脉相位图像：通过栓剂跟踪定时（41 例）或在注射对比剂后 20 秒固定（43 例）：71名患者有PHPT症状，血钙中位数为12.1 mg/dL。在4D-CT的动脉期，88.1%的病变有极性血管征，其中7/9为无症状患者，6/6为甲状旁腺癌，3/4为异位（1：纵隔，2：甲状胸腺韧带）。极性血管征的预测因素包括病变最大尺寸（2.2 cm vs. 1.4 cm; P = 0.03）、实性囊性CT形态（47.3% vs. none; P = 0.004）和栓质追踪定时动脉相位（55.4% vs. none; P = 0.001）。其中，栓剂追踪提高了极性血管的可视化（100% 对 76.7%；P = 0.001），与病变尺寸和实性囊肿形态无关。后两者可预测以固定间隔（20 秒）获取的图像中极性血管的征象。栓剂跟踪定时扫描中病变动脉百分比增强（PAE）的比例明显较低结论：极性血管征在 CT 报告中对 PAE 起着补充作用。栓剂追踪在优化血管和肿瘤动脉增强方面很有价值，很容易纳入甲状旁腺 4D-CT 方案。

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

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.