{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T22:06:15Z","timestamp":1791324375985,"version":"4.3.1"},"reference-count":30,"publisher":"Royal College of Surgeons of England","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["annals"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p> Accurate preoperative localisation of parathyroid adenoma is imperative for the success of minimally invasive parathyroidectomy (MIP). <\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p> Our study aimed to evaluate the role of four-dimensional computer tomography (4D-CT) scan as an imaging modality in patients with failed and discordant localisation reported in the first-line imaging modalities (ultrasonography and <jats:sup>99m<\/jats:sup>Tc-MIBI-SPECT\/CT). <\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p> This is a prospective cohort study performed at a university teaching centre from March 2013 to July 2021. All patients with primary hyperparathyroidism who had failed localisation by ultrasonography and <jats:sup>99m<\/jats:sup>Tc-MIBI-SPECT\/CT (SpCT), or discordance between them, had 4D-CT performed in this study. <\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p> One hundred and two sporadic cases of pHPT with failed\/discordant first-line imaging had 4D-CT imaging prior to parathyroidectomy. In 102 patients, 105 parathyroid adenomas were reported on histopathology. 4D-CT was able to localise 78% of them to the correct side and 64% to the correct quadrant in 102 patients, as compared with US (correct side 21%, correct quadrant 16%) and <jats:sup>99m<\/jats:sup>Tc-MIBI-SPECT\/CT (correct side 36%, correct quadrant 31%). 4D-CT had a sensitivity, precision, accuracy and F1 score for correct quadrant localisation as 79%, 81%, 66% and 80%; and for correct side localisation as 82%, 98%, 80% and 89%, respectively. 4D-CT was able to identify three ectopic adenomas (two in superior mediastinum and one in the oesophageal wall) which were not detected on US or SpCT. <\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p> 4D-CT was found to be sensitive and accurate in preoperative localising of the diseased parathyroid glands after failed\/discordant US and SpCT. This led to more patients being offered MIP as the primary surgery and improved operative outcomes. <\/jats:p><\/jats:sec>","DOI":"10.1308\/rcsann.2022.0126","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T23:00:38Z","timestamp":1698793238000},"page":"739-746","source":"Crossref","is-referenced-by-count":10,"title":["Role of four-dimensional computer tomography (4D-CT) in non-localising and discordant first-line imaging in primary hyperparathyroidism"],"prefix":"10.1308","volume":"105","author":[{"given":"S","family":"Sayed","sequence":"first","affiliation":[{"name":"CancerCare Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Das","sequence":"additional","affiliation":[{"name":"Dr. Bhubaneswar Borooah Cancer Institute, Guwahati, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B","family":"Turner","sequence":"additional","affiliation":[{"name":"CancerCare Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"VS","family":"Wadhwa","sequence":"additional","affiliation":[{"name":"Cedars Sinai Medical Center, Los Angeles, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"KA","family":"Pathak","sequence":"additional","affiliation":[{"name":"CancerCare Manitoba, Winnipeg, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"171","reference":[{"key":"C1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)31430-7"},{"key":"C2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2012-4022"},{"key":"C3","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-1215"},{"key":"C4","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.2310"},{"key":"C5","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.6437"},{"key":"C6","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-008-0408-1"},{"key":"C7","doi-asserted-by":"publisher","DOI":"10.1186\/s13550-021-00778-7"},{"key":"C8","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2009.12.005"},{"key":"C9","first-page":"359","volume":"35","author":"Akbaba G","year":"2012","journal-title":"J Endocrinol Invest"},{"key":"C10","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-017-6115-9"},{"key":"C11","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-011-1870-5"},{"key":"C12","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2006.07.028"},{"key":"C13","doi-asserted-by":"publisher","DOI":"10.1097\/MNM.0000000000001331"},{"key":"C14","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-014-3940-y"},{"key":"C15","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-011-1365-3"},{"key":"C16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2016.06.022"},{"key":"C17","doi-asserted-by":"publisher","DOI":"10.1007\/s00259-002-0944-9"},{"key":"C18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2015.11.044"},{"key":"C19","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.2649"},{"key":"C20","first-page":"551","volume":"39","author":"Marzouki HZ","year":"2010","journal-title":"J Otolaryngol Head Neck Surg"},{"key":"C21","first-page":"e13550","volume":"13","author":"Marzouki HZ","year":"2021","journal-title":"Cureus"},{"key":"C22","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4199"},{"key":"C23","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318208fed9"},{"key":"C24","first-page":"e21177","volume":"14","author":"Hillyar CR","year":"2022","journal-title":"Cureus"},{"key":"C25","doi-asserted-by":"publisher","DOI":"10.1177\/0145561319828668"},{"key":"C26","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0b013e31817dec15"},{"key":"C27","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-011-1404-0"},{"key":"C28","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2013.6780"},{"key":"C29","doi-asserted-by":"publisher","DOI":"10.1177\/0194599815599372"},{"key":"C30","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.12110852"}],"container-title":["The Annals of The Royal College of Surgeons of England"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/pdf\/10.1308\/rcsann.2022.0126","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,6]],"date-time":"2023-11-06T10:12:11Z","timestamp":1699265531000},"score":1,"resource":{"primary":{"URL":"https:\/\/publishing.rcseng.ac.uk\/doi\/10.1308\/rcsann.2022.0126"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11]]},"references-count":30,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1308\/rcsann.2022.0126"],"URL":"https:\/\/doi.org\/10.1308\/rcsann.2022.0126","relation":{},"ISSN":["0035-8843","1478-7083"],"issn-type":[{"value":"0035-8843","type":"print"},{"value":"1478-7083","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11]]}}}