Parathyroid Exploration in the Reoperative Neck: Improved Preoperative Localization with 4D-Computed Tomography

摘要: Background Reoperation for hyperparathyroidism (HPT) carries an increased risk morbidity and failure to cure. Accurate preoperative localization minimizes operative but is often difficult achieve in the reoperative setting. Four-dimensional computed tomography (4D-CT) emerging technique that uses functional parathyroid anatomy precise localization. We evaluated 4D-CT as a tool of hyperfunctioning tissue Study Design A prospective endocrine database was queried identify 45 patients who underwent parathyroidectomy after using 4D-CT. The were categorized into 1 3 groups: group included those had previous neck surgery non-HPT conditions; 2 undergone previously unsuccessful exploration HPT; with HPT resection at least hypercellular parathyroid. Results sensitivity 88% compared 54% sestamibi imaging. CT more correctly localized (p=0.0003) lateralized (p=0.005) hyperfunctional than did. successfully 18 (82%) 22 patients, 10 (91%) 11 8 (67%) 12 patients. Three lost followup. At mean followup 9.8 months, 39 (93%) 42 surgically cured (7%; 3) persistent HPT. Conclusions Four-dimensional-CT ideal Localization successful reoperation are most have earlier operation one suggesting multigland disease.