Diagnostic performance of parathyroid 4d-ct in men1 syndrome-associated primary hyperparathyroidism

Anima Sharma; Nivedita Chakrabarty; Virendra Patil; Hemangini Thakkar; Padma Badhe; Mahadeo Garale; Saba Memon; Anurag Lila; Manjiri Karlekar; Rohit Barnabas; Ketki Ambulkar; Tushar Bandgar

doi:10.1530/endoabs.110.OC7.2

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Endocrine Abstracts (2025) 110 OC7.2 | DOI: 10.1530/endoabs.110.OC7.2

ECEESPE2025 Oral Communications Oral Communications 7: Bone and Mineral Metabolism (9 abstracts)

Diagnostic performance of parathyroid 4d-ct in men1 syndrome-associated primary hyperparathyroidism

Anima Sharma ¹ , Nivedita Chakrabarty ² , Virendra Patil ¹ , Hemangini Thakkar ¹ , Padma Badhe ¹ , Mahadeo Garale ¹ , Saba Memon ¹ , Anurag Lila ¹ , Manjiri Karlekar ¹ , Rohit Barnabas ¹ , Ketki Ambulkar ¹ & Tushar Bandgar ¹

Author affiliations

¹Seth G.S. Medical College and King Edward Memorial Hospital, Mumbai, India; ²Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India

JOINT1472

Background: In multiple endocrine neoplasia type 1 (MEN1) related primary hyperparathyroidism (PHPT), recognition of asynchronous parathyroid involvement has led to consideration for targeted surgical approaches that require accurate preoperative localization modalities. However, data on parathyroid 4-dimensional computed tomography (4D-CT) in this context remains sparse.

Objectives: To assess 4D-CT diagnostic performance in MEN1 PHPT and report outcomes of parathyroidectomy where surgical extent was tailored as per the CT findings.

Study setting: Retrospective study in an endocrine referral center where 4D-CT is routinely used as first-line imaging for parathyroid localization.

Methods: CT scans of MEN1 PHPT patients from Jan 2008–Dec 2022 (20% clinical, 80% genetic diagnosis) were independently reviewed by two radiologists (15 & 11 years of experience) aware of MEN1 but blinded to original radiology reports, clinical/surgical details, histopathology, and outcomes. The per-patient analysis comprised the entire cohort. The per lesion analysis was limited to operated patients and used pathology/surgical outcome as the gold standard.

Results: Among 60 MEN1 PHPT patients, 43% were symptomatic and 93% had hypercalcemia at the time of CT (median calcium 11.7 mg/dl, PTH 248 pg/ml). The per-patient analysis included 61 4D-CT scans (53 previously unoperated, 8 for persistent/recurrent PHPT). The original report and radiologists identified abnormal glands in 96.7-100% of patients (mean 2.25 lesions per patient in unoperated, 1.71 in persistent/recurrent). In the per lesion analysis (n=33), 4D-CT had 85-89.5% sensitivity and 90-94% specificity, outperforming ultrasonography and Sestamibi scan (P<0.001 for both). There was good inter-observer agreement on CT for lesion quadrant localization in the overall cohort and operated subgroup (Cohen’s kappa 0.64-0.91). In 24/33 patients, only CT-identified abnormal glands were resected, while glands not seen on CT were left unexplored (imaging-guided group). The remaining 9 had bilateral neck exploration (BNE) with subtotal/total parathyroidectomy and autotransplantation, regardless of CT findings. Both imaging-guided and BNE groups had similar baseline characteristics and number of lesions identified per patient on 4D-CT. The imaging-guided group had more adenomas and fewer hyperplasia (35% vs. 64%; P<0.001) and normal glands (2% vs. 17%; P=0.01) on pathology than BNE. Despite resecting fewer glands per patient (P<0.001), the imaging-guided group had comparable remission (91.7% vs 100%) and recurrence rates (9.5% vs 0%; P=1.00) to the BNE group over similar follow-up duration, with lower permanent hypoparathyroidism (4 vs. 44%; P=0.01).

Conclusion: 4D-CT demonstrated good diagnostic performance and facilitated favorable operative outcomes in MEN1 PHPT, supporting its role in planning surgical extent.