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      Four-dimensional computed tomography protocol for preoperative evaluation of the parathyroid glands and its correlations with other imaging methods: a pictorial essay Translated title: Protocolo de tomografia computadorizada quadridimensional para avaliação pré-operatória da paratireoide e correlação com outros métodos de imagem: ensaio iconográfico

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          Abstract

          Parathyroid adenoma is the most common cause of primary hyperparathyroidism. Advances in surgical techniques have made it possible to excise only the affected parathyroid gland in most cases. Imaging examinations play a fundamental role in the preoperative planning of parathyroidectomy. To localize the parathyroid glands, imaging tests such as scintigraphy, ultrasound, and, more recently, four-dimensional computed tomography (4D CT). The aim of this pictorial review was to illustrate the use of the 4D CT protocol in cases of parathyroid adenoma and to determine how well it correlates with other imaging methods, in order to improve understanding of the 4D CT method.

          Translated abstract

          O adenoma de paratireoide é a causa mais comum de hiperparatireoidismo primário. Com o avanço das técnicas cirúrgicas, na maioria das vezes é realizada a retirada apenas da paratireoide afetada. Para que isso seja possível, os exames de imagem têm papel fundamental. São utilizados para a localização das paratireoides exames como a cintilografia e a ultrassonografia, e recentemente a tomografia computadorizada quadridimensional (TC 4D) com protocolo específico. O objetivo deste ensaio é descrever o uso do protocolo TC 4D em casos de adenoma da paratireoide e determinar sua correlação com os outros métodos de imagem, para facilitar o entendimento do método.

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          How to perform parathyroid 4D CT: tips and traps for technique and interpretation.

          Parathyroid four-dimensional (4D) computed tomography (CT) is an imaging technique for preoperative localization of parathyroid adenomas that involves multidetector CT image acquisition during two or more contrast enhancement phases. Four-dimensional CT offers an alternative or additional tool in the evaluation of primary hyperparathyroidism. The purpose of this article is to describe the 4D CT technique and provide a practical guide to the radiologist for imaging interpretation. The article will discuss the rationale for imaging, approach to interpretation, imaging findings, and pitfalls.
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            Parathyroid scintigraphy in patients with primary hyperparathyroidism: 99mTc sestamibi SPECT and SPECT/CT.

            The clinical diagnosis of primary hyperparathyroidism is based largely on serum laboratory test results, as patients often are asymptomatic. Surgery, often with bilateral exploration of the neck, has been considered the definitive treatment for symptomatic disease. However, given that approximately 90% of cases are due to a single parathyroid adenoma, a better treatment may be the selective surgical excision of the hyperfunctioning parathyroid gland after its preoperative identification and localization at radiologic imaging. Scintigraphy and ultrasonography are the imaging modalities most often used for preoperative localization. Various scintigraphic protocols may be used in the clinical setting: Single-phase dual-isotope subtraction imaging, dual-phase single-isotope imaging, or a combination of the two may be used to obtain planar or tomographic views. Single photon emission computed tomography (SPECT) with the use of technetium-99m ((99m)Tc) sestamibi as the radiotracer, especially when combined with x-ray-based computed tomography (CT), is particularly helpful for preoperative localization: The three-dimensional functional information from SPECT is fused with the anatomic information obtained from CT. In addition, knowledge of the anatomy and embryologic development of the parathyroid glands and the pathophysiology of primary hyperparathyroidism aid in the identification and localization of hyperfunctioning glands. (c) RSNA, 2008.
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              Parathyroid Adenomas and Hyperplasia on Four-dimensional CT Scans: Three Patterns of Enhancement Relative to the Thyroid Gland Justify a Three-Phase Protocol.

              To describe the prevalence of three relative enhancement patterns of parathyroid lesions on four-dimensional (4D) computed tomographic (CT) scans.
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                Author and article information

                Journal
                Radiol Bras
                Radiol Bras
                rb
                Radiologia Brasileira
                Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem
                0100-3984
                1678-7099
                May-Jun 2021
                May-Jun 2021
                : 54
                : 3
                : 193-197
                Affiliations
                [1 ] Department of Imaging - A.C.Camargo Cancer Center, São Paulo, SP, Brazil.
                Author notes
                Correspondence: Dra. Stephanie Yuka Matwijszyn Nagano. Departamento de Imagem - A.C.Camargo Cancer Center. Rua Professor Antônio Prudente, 211, Liberdade. São Paulo, SP, Brazil, 09015-010. Email: ste1994@ 123456gmail.com .
                Author information
                http://orcid.org/0000-0001-8918-4907
                http://orcid.org/0000-0003-0192-9885
                http://orcid.org/0000-0002-4712-5500
                http://orcid.org/0000-0001-7892-1983
                Article
                10.1590/0100-3984.2020.0056
                8177685
                577c076b-d3de-4c52-99c3-6d94faf7e7c7

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 May 2020
                : 18 June 2020
                Categories
                Pictorial Essay

                adenoma/diagnostic imaging,parathyroid neoplasms/diagnostic imaging,hyperparathyroidism/surgery,four-dimensional computed tomography/methods,adenoma/diagnóstico por imagem,neoplasias das paratireoides/diagnóstico por imagem,hiperparatireoidismo/cirurgia,tomografia computadorizada quadridimensional/métodos

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