North Pacific Surgical AssociationDual-energy computed tomography: a promising novel preoperative localization study for treatment of primary hyperparathyroidism

BackgroundThe objective of this study was to evaluate dual-energy computed tomography (DE-CT) for preoperative parathyroid tumor (PT) localization in individuals undergoing parathyroidectomy for treatment of primary hyperparathyroidism (PHP).MethodsDE-CT was evaluated by retrospective review of the clinical and biochemical characteristics, imaging, operative findings, and outcomes for PHP cases undergoing an initial operation at a single center.ResultsThe accuracy of each preoperative imaging test, based on operative findings and pathological confirmation of removal of a PT from the localized site was: 58% for ultrasound, 75% Tc-99m sestamibi noncontrast single photon emission noncontrast CT, and 75% for DE-CT. DE-CT was able to correctly localize a PT in a 3rd of cases that were nonlocalized. All study patients had normalization of serum calcium and parathyroid hormone levels postoperatively.ConclusionsDE-CT shows promise for the preoperative PT localization, especially in nonlocalized PHP cases, and warrants further investigation.