Diagnostic performance of parathyroid CT and CT-guided targeted parathyroidectomy in MEN1-associated primary hyperparathyroidism.

BACKGROUND

Accurate preoperative imaging is essential for successful targeted parathyroidectomy (targeted-PTX), which is gaining interest in MEN1-associated primary hyperparathyroidism (MEN1-PHPT). Parathyroid computed tomography (CT) performance data in this population are scarce, and CT-guided targeted-PTX represents a novel approach. We aimed to assess parathyroid CT diagnostic performance and CT-guided targeted-PTX outcomes in MEN1-PHPT.

METHODS

MEN1-PHPT patients undergoing parathyroid CT at a tertiary institution (2015-2022) were included. CT performance was analyzed per-patient (entire-cohort) and per-lesion (operated-subgroup using histopathology and surgical outcomes as gold standard). For interobserver agreement, CT report from medical records was compared with CT reports generated on independent blinded-review by two radiologists. Outcomes were compared between two post-CT surgical approaches: bilateral neck exploration-guided subtotal/total parathyroidectomy (BNE-guided SPTX/TPTX) and CT-guided targeted-PTX (only CT-visible glands resected).

RESULTS

Sixty MEN1-PHPT patients (age 13.9-65 years) were included. On per-patient analysis, abnormal parathyroid glands were visible on all CT scans (1, 2, 3, 4 glands in 23%, 48%, 21%, 8%). On per-lesion analysis (n=33, 133 gland sites), CT sensitivity, specificity, and accuracy (95% CI) were 85% (76-91%), 94% (84-98%), and 89%, respectively, higher than ultrasonography/99mTechnetium-Sestamibi (P<0.001). Blinded readers' reviews showed similar performance with good interobserver agreement. Preoperative clinical characteristics and number of glands identified on CT (median, 2 per-patient) were similar between BNE-guided SPTX/TPTX (n=9) and CT-guided targeted-PTX (n=24) groups. Compared with BNE-guided SPTX/TPTX, CT-guided targeted-PTX involved resection of significantly fewer glands per-patient while achieving comparable remission and recurrence over similar follow-up duration, with lower prolonged hypoparathyroidism (P=0.01).

CONCLUSION

Our findings indicate parathyroid CT's utility as a preoperative imaging modality in MEN1-PHPT.