PT  - JOURNAL ARTICLE
AU  - Becker, J.L.
AU  - Patel, V.
AU  - Johnson, K.J.
AU  - Guerrero, M.
AU  - Klein, R.R.
AU  - Ranvier, G.F.
AU  - Owen, R.P.
AU  - Pawha, P.
AU  - Nael, K.
TI  - 4D–Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism
AID  - 10.3174/ajnr.A6482
DP  - 2020 Mar 01
TA  - American Journal of Neuroradiology
PG  - 522--528
VI  - 41
IP  - 3
4099  - http://www.ajnr.org/content/41/3/522.short
4100  - http://www.ajnr.org/content/41/3/522.full
SO  - Am. J. Neuroradiol.2020 Mar 01; 41
AB  - BACKGROUND AND PURPOSE: Our aim was to test the hypothesis that our recently introduced 4D–dynamic contrast-enhanced MR imaging with high spatial and temporal resolution has equivalent accuracy to 4D-CT for preoperative gland localization in primary hyperparathyroidism without requiring exposure to ionizing radiation.MATERIALS AND METHODS: Inclusion criteria were the following: 1) confirmed biochemical diagnosis of primary hyperparathyroidism, 2) preoperative 4D–dynamic contrast-enhanced MR imaging, and 3) surgical cure with >50% decrease in serum parathyroid hormone intraoperatively. 4D–dynamic contrast-enhanced studies were reviewed independently by 2 neuroradiologists to identify the side, quadrant, and number of abnormal glands, and compared with surgical and pathologic results.RESULTS: Fifty-four patients met the inclusion criteria: 37 had single-gland disease, and 17, multigland disease (9 with double-gland hyperplasia; 3 with 3-gland hyperplasia; and 5 with 4-gland hyperplasia). Interobserver agreement (κ) for the side (right versus left) was 0.92 for single-gland disease and 0.70 for multigland disease. Interobserver agreement for the quadrant (superior versus inferior) was 0.70 for single-gland disease and 0.69 for multigland disease. For single-gland disease, the gland was correctly located in 34/37 (92%) patients, with correct identification of the side in 37/37 (100%) and the quadrant in 34/37 (92%) patients. For multigland disease, the glands were correctly located in 35/47 (74%) patients, with correct identification of the side in 35/47 (74%) and the quadrant in 36/47 (77%).CONCLUSIONS: The proposed high spatial and temporal resolution 4D–dynamic contrast-enhanced MR imaging provides excellent diagnostic performance for preoperative localization in primary hyperparathyroidism, with correct gland localization of 92% for single-gland disease and 74% in multigland disease, superior to 4D-CT studies.CAIPIRINHAcontrolled aliasing in parallel imaging results in higher accelerationDCEdynamic contrast-enhancedMGDmultigland diseasePHPTprimary hyperparathyroidismPTAsingle parathyroid adenomaPTHparathyroid hormoneSGDsingle-gland diseaseTRICKStime-resolved imaging of contrast kineticsTWISTtime-resolved imaging with stochastic trajectories