{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:46:42Z","timestamp":1787014002658,"version":"build-2736575974"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,7,31]],"date-time":"2017-07-31T00:00:00Z","timestamp":1501459200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2017,12]]},"abstract":"Summary<\/jats:title>\n \n Background<\/jats:title>\n \n Radiation exposure to neck by four\u2010dimensional computerized tomography (4\n DCT<\/jats:styled-content>\n ) is relatively high and limits its use as a first\u2010line investigation in evaluation of primary hyperparathyroidism (\n PHPT<\/jats:styled-content>\n ). Radiation exposure can be reduced by restricting the number of\n CT<\/jats:styled-content>\n phases. Our aim was to study the performance of 4\n DCT<\/jats:styled-content>\n in cohort of surgery\u2010na\u00efve\n PHPT<\/jats:styled-content>\n patients, and to evaluate percentage enhancement as an objective radiological index to discriminate parathyroid lesions (adenoma\/hyperplasia) from thyroid tissue and lymph nodes.\n <\/jats:p>\n <\/jats:sec>\n \n Materials and method<\/jats:title>\n \n Retrospective study of 49\n PHPT<\/jats:styled-content>\n patients {(44 single\u2010gland diseases (\n SGD<\/jats:styled-content>\n ) and five multiple\u2010gland disease (\n MGD<\/jats:styled-content>\n )} who underwent 4\n DCT<\/jats:styled-content>\n (unenhanced, early arterial, early venous and delayed venous phase) pre\u2010operatively. Two radiologists who were blinded to surgical location of parathyroid lesions examined the scans. Attenuation values were recorded for parathyroid lesions (n=50), thyroid gland (n=50) and lymph nodes (n=12) in different phases. Percentage enhancement for different phases was calculated as \u201c(\n HU<\/jats:styled-content>\n in a specific enhanced phase\u2010\n HU<\/jats:styled-content>\n in unenhanced phase)\/\n HU<\/jats:styled-content>\n in unenhanced phase\u201d \u00d7100.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Inter\u2010rater reliability between the two radiologists was 0.83 (Cohen's kappa). In\n SGD<\/jats:styled-content>\n , sensitivity and\n PPV<\/jats:styled-content>\n were 93.18% and 98.8% for lateralization, and 89.77% and 95.18% for quadrant localization, respectively. In\n MGD<\/jats:styled-content>\n , 4\n DCT<\/jats:styled-content>\n showed 50% sensitivity and 100%\n PPV<\/jats:styled-content>\n . Percentage arterial enhancement showed highest area under curve (\n AUC<\/jats:styled-content>\n =0.992) for differentiation of parathyroid lesions from thyroid tissue and lymph nodes. A cut\u2010off value of 128.9% showed 95.8% sensitivity and 100% specificity for the identification of parathyroid lesions.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n We propose that percentage arterial enhancement can be used as an objective radiological index for accurate identification of parathyroid adenoma\/hyperplasia.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/cen.13406","type":"journal-article","created":{"date-parts":[[2017,6,28]],"date-time":"2017-06-28T03:56:45Z","timestamp":1498622205000},"page":"791-798","source":"Crossref","is-referenced-by-count":21,"title":["Percentage arterial enhancement: An objective index for accurate identification of parathyroid adenoma\/hyperplasia in\u00a0primary hyperparathyroidism"],"prefix":"10.1111","volume":"87","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7679-6656","authenticated-orcid":false,"given":"Manjunath","family":"Goroshi","sequence":"first","affiliation":[{"name":"Department of Endocrinology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anurag R.","family":"Lila","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1251-8918","authenticated-orcid":false,"given":"Swati S.","family":"Jadhav","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushil","family":"Sonawane","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Hira","sequence":"additional","affiliation":[{"name":"Department of Radiology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shetteppa","family":"Goroshi","sequence":"additional","affiliation":[{"name":"Department of Radiology Sri Nijalingappa Medical College Bagalkot Bagalkot India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahadev N.","family":"Garle","sequence":"additional","affiliation":[{"name":"Department of Surgery Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhay","family":"Dalvi","sequence":"additional","affiliation":[{"name":"Department of Surgery Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pragati","family":"Sathe","sequence":"additional","affiliation":[{"name":"Department of Pathology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tushar R.","family":"Bandgar","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nalini S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Seth GS Medical College and KEM Hospital Mumbai India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,7,31]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2004.10.005"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-2000"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318208fed9"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2006.07.028"},{"key":"e_1_2_5_6_1","first-page":"731","article-title":"Clinical efficacy of 2\u2010phase versus 4\u2010phase computed tomography for localization in primary hyperparathyroidism","volume":"160","author":"Ramirez AG","year":"2016","journal-title":"Surg (United States)"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1413"},{"key":"e_1_2_5_8_1","volume-title":"EUR. 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