Methodology of 4D computed tomography in diagnosis of pathologically changed parathyroid glands in patients with primary hyperparathyroidism
Journal Title: Український журнал дитячої ендокринології - Year 2018, Vol 0, Issue 3
Abstract
Objective — to study and implement methodologies of 4D computed tomography (CT) in diagnosis of pathologically changed parathyroid glands (PTG) in patients with primary hyperparathyroidism (PHPT). Materials and methods. In the course of research we have examined 86 patients diagnosed with primary hyperparathyroidism — 66 women and 20 men (3:1 ratio) aged 40 to 75 years, as well 2 children below 10 years old. 4D CT was conducted using «Toshiba Aquilion 64» unit in the Ukrainian Scientific and Practical Center for Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health Care of Ukraine. «Ultravist 370» was used as a contrast agent, administered intravenously in quantity of 100 ml with speed of 4 ml/s. Scanning protocol consisted of three phases: native, arterial, phase (image is acquired 25 s after beginning of contrast agent administration), venous, or postponed, phase (90 s after beginning of contrast agent administration). Scanning field — from gonial angle to tracheal bifurcation. Scanning parameters: voltage — 120 kV, exposure — 250–300 mAs, slice thickness — 0.5 mm. Results and discussion. In structure of the pathology identified by using 4D CT, of the most significant specific gravity are adenomas of PTG — 75 cases. The remaining cases include: hyperplasia of PTG — 4 cases (of which 2 are children), carcinoma — 2 cases, cyst — 3 cases. In 2 patients (2.3 %), adenomas of PTG have not been detected by CT due to intrathyroidal location. In 34 (40 %) cases, changed PTG were located typically — on the posterior surface of TG (in 2 cases they were 6—7 cm in size), while in 50 cases they were located ectopically. Among the ectopically located adenomas of PTG, 12 (24 %) have been localized in tracheoesophageal angle, 2 cases (4 %) in retropharyngeal space and another 2 in upper section of anterior mediastinum, 3 (6 %) in thyrothymic ligament and another 3 — retroclavicularly, as well as 1 (2 %) in paraaortic space. Conclusions. Images acquired as a result of 4D CT methodology provide both anatomical and functional information (based on changes of perfusion) and can be interpreted by a surgeon at preoperative stage. This enables surgeons to optimize surgical approach.
Authors and Affiliations
M. O. Urina, V. O. Palamarchuk
Keywords
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- EP ID EP460834
- DOI 10.30978/UJPE2018-3-4-39
- Views 98
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