Computed tomography of the parathyroids: The value of density measurements to distinguish between parathyroid adenomas of the lymph nodes and the thyroid parenchyma

PurposeTo compare the densities of parathyroid adenomas, lymph nodes and the thyroid parenchyma during multi-phase cervico-thoracic computed tomography to determine the differentiating threshold values.Materials and methodsThis study comprises 30 patients operated for a parathyroid adenoma after computed tomography without injection and then 45 and 70 seconds after the injection of an iodine based contrast product (350 mgI/mL, 150 mL, 3 mL/s). The density of the adenomas, lymph nodes and thyroid was measured during the three phases (D0, D45, D70). The relative enhancement (RE) at 45 seconds was calculated: RE = (D45 – D0) / D0.ResultsA significant difference was found in the spontaneous density of the parathyroid adenomas of the thyroid (P < 0.01) with a threshold value of 75 HU. A significant difference is found in the enhancement after injection of the adenomas and lymph nodes (P < 0.01). The adenomas present an enhancement peak at 45 seconds while the maximum enhancement of the lymph nodes is at 70 seconds. At 45 seconds, a threshold value of 114 HU and an RE 125% allows them to be distinguished (sensitivity and specificity 0.96).ConclusionMeasurement of the densities can differentiate between the parathyroid adenomas, lymph nodes and thyroid.