{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:24:10Z","timestamp":1785410650222,"version":"3.56.0"},"reference-count":28,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,5,12]],"date-time":"2021-05-12T00:00:00Z","timestamp":1620777600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Parathyroid computed tomography using multiple phases (four\u2010dimensional computed tomography (4DCT) for parathyroid localization was first described in 2006. Since its inception, there has been variable uptake of this technique due to inconsistency of results between institutions and perceived higher radiation dose than technetium\u201099 sestamibi scans (MIBI). 4DCT has been the primary imaging modality for parathyroid localization at our institution since 2013.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective study of surgically managed patients with primary hyperparathyroidism who had preoperative localization with 4DCT from 2013\u20132018 was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 353 patients were included for analysis. The positive predictive value (PPV) of our three\u2010phase 4DCT protocol was 93.3%, sensitivity (localized) 85.2% with a 5.8% false\u2010positive rate and 13.9% false\u2010negative (non\u2010localizing) rate when reported by a head and neck radiologist (HNR). Calculated effective dose varied from 4.5 to 8.9mSV. On multivariable logistic regression, reporting by an experienced HNR (<jats:italic>P<\/jats:italic>\u00a0&lt;\u20090.001) and gland weight\u2009&gt;\u2009200\u2009mg (<jats:italic>P<\/jats:italic>\u00a0=\u20090.002) were significant for higher accuracy, lower false positives and false negatives.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A first\u2010line three\u2010phase 4DCT protocol for primary hyperparathyroidism is an accurate technique providing precise anatomical localization of abnormal parathyroid glands, particularly when performed by a specialist HNR. In our practise, it provides the best rate of detection and superior anatomical localization needed for minimally invasive parathyroid surgery, compared to other commonly used localization techniques. It also avoids the need for four gland exploration in the majority of patients with primary hyperparathyroidism.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.16924","type":"journal-article","created":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T05:00:00Z","timestamp":1620882000000},"page":"1798-1803","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Three\u2010phase four\u2010dimensional computed tomography as a first\u2010line investigation in primary hyperparathyroidism"],"prefix":"10.1111","volume":"91","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4552-9579","authenticated-orcid":false,"given":"David","family":"Leong","sequence":"first","affiliation":[{"name":"Endocrine Surgical Services Sir Charles Gairdner Hospital  Western Australia Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina","family":"Ng","sequence":"additional","affiliation":[{"name":"Endocrine Surgical 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