Diagnostic Accuracy of Four-Dimensional Computed Tomography in Preoperative Localization of Primary Hyperparathyroidism After Negative or Inconclusive Sestamibi: A Systematic Review and Meta-analysis.

Objective: The aim of the study is to assess the diagnostic accuracy of 4-dimensional computed tomography (4D-CT) scans for patients with primary hyperparathyroidism (pHPT) after negative or inconclusive Technetium-99m sestamibi single-photon emission computed tomography scan.

Methods: A literature search of several databases was conducted from inception to August 2023. Eligible studies reported adult patients (>18 years old) who underwent 4D-CT after negative or inconclusive sestamibi results. The pooled proportions were analyzed using a random-effects model. This review was registered in PROSPERO (CRD42023446285).

Results: From 208 initial studies screened, 10 met the eligibility criteria, with a total of 335 patients with a diagnosis of pHPT who underwent 4D-CT scans and subsequent surgical exploration. Nine of the studies reported a pooled sensitivity of localization of 71% (0.71; 95% confidence interval [CI]: 0.610, 0.811, I2  = 72%). The pooled specificity of localization across 5 studies was calculated at 47% (0.47; 95% CI: -0.111, 1.059, I2  = 99%). Seven of the included studies reported a pooled positive predictive value of 81% (0.81; 95% CI: 0.708, 0.917, I2  = 70%), and 6 of the studies reported a negative predictive value of 28% (0.28; 95% CI: -0.114, 0.683, I2  = 98%).

Conclusions: For pHPT patients with inconclusive sestamibi scans, 4D-CT demonstrates promising results with good diagnostic accuracy for the localization of pHPT. Additional studies evaluating larger groups of patients may provide further support for the use of 4D-CT in this population.