4D–Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism

J.L. Becker; V. Patel; K.J. Johnson; M. Guerrero; R.R. Klein; G.F. Ranvier; R.P. Owen; P. Pawha; K. Nael

doi:10.3174/ajnr.A6482

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Fig 1.
A 39-year-old woman with PHPT and MGD with bilateral glands imaged in the lower quadrants. A, Axial early arterial phase. B, Early venous phase. C, Midvenous phase. D, Later venous phase. The contour of the glands is different in A and B due to interval patient motion without image degradation. Images show bilateral MGD glands (white arrows) with early arterial enhancement and increased signal intensity compared with the adjacent thyroid gland (A). Signal intensity increases into the early venous phase, with MGD glands having signal intensity similar to that of the carotid artery on the early venous phase and increased signal compared with the thyroid gland (B). At the mid-venous phase, the MGD glands have decreased signal intensity compared with the carotid artery due to early washout but still have increased signal compared with the thyroid gland (C). The MGD gland signal decreases further in the later venous phase, becoming isointense with the thyroid gland (D).
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Fig 2.
A 54-year-old woman with PHPT and SGD in the left lower quadrant. A, Axial early arterial phase. B, Early venous phase. C, Midvenous phase. D, Later venous phase. Images show a left lower quadrant parathyroid adenoma (white arrow) with early arterial enhancement (A), increasing with signal intensity similar to that of the internal carotid artery (B), with mildly decreased signal intensity compared with the carotid artery due to early venous washout (C), and decreased signal intensity compared with the adjacent internal carotid artery and jugular vein in the later venous phase (D).

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Table 1:

Baseline and clinical data in patients with single adenoma and multiglandular disease (univariate analysis)

Variable	Total (54)	SGD (n = 37)	MGD (n = 17)	P Value
Age (mean) (SD) (yr)	58.6 (13.2)	59.1 (12.0)	57.4 (15.5)	.66
Sex (M/F)	(14/40)	(10/27)	(4/13)	.70
Preoperative PTH (mean) (SD)	131.6 (62.6)	134.2 (63.2)	148.8 (109.2)	.56
Preoperative calcium (mean) (SD)	10.8 (0.6)	10.8 (0.7)	10.7 (0.47)	.47
Volume (cm³) (mean) (SD)	4.25 (6.51)	4.38 (1.09)	1.01 (2.24)	.02
Weight (mean) (SD) (g)	0.60 (0.51)	0.95 (0.60)	0.34 (0.26)	.001

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Table 2:

MGD—results for identification of side and quadrant of glands

	No. of Glands (Total, 47)
	Reader 1	Reader 2	Consensus
Side (right or left)
Total correctly localized	35 (74%)	33 (70%)	35 (74%)
Total incorrectly localized	2 (4%)	1 (2%)	2 (4%)
Total not identified at all	10 (21%)	13 (28%)	10 (21%)
Quadrant (superior or inferior)
Total correctly localized	33 (70%)	32 (68%)	36 (77%)
Total incorrectly localized	3 (6%)	2 (4%)	2 (4%)
Total not identified at all	11 (23%)	13 (28%)	9 (19%)

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Table 3:

SGD and MGD—patient results for identification of side and quadrant of glands

	No. of Patients (Total, 17)
Side (right or left)
Total with all glands correctly localized	14 (82%)
Total with 1 gland incorrectly localized	2 (12%)	2/9 with 2-gland disease
Total with 1 gland not identified at all	1 (6%)	1/9 with 2-gland disease
Quadrant (superior or inferior)
Total with all glands correctly localized	9 (53%)
		7/9 with 2-gland disease
		1/3 with 3-gland disease
		1/5 with 3.5-gland disease
Total with 1 gland incorrectly localized	2^{^a}
		1/3 with 3-gland disease
		1 with 3.5-gland disease also had 1 gland not identified and counted twice^{^a}
Total with 1 gland not identified	6^{^a}	2/9 with 2-gland disease
		1/3 with 3-gland disease
		3/5 with 3.5-gland disease
Total with 2 glands not identified	1	1/5 with 3.5-gland disease