Thread by @pbunchmd

Some points from my #ASNR20 parathyroid 4D CT talk broadcast now and soon available on-demand:

• primary hyperparathyroidism (PHPT) - intrinsic parathyroid gland abnormality resulting in excessive PTH secretion

• PHPT diagnosed with blood tests (specifically Ca and PTH)

• Most often (85-90%) caused by single adenoma (1 gland problem); less often by abnormality of more than 1 gland

• Cure - surgical removal of abnormal parathyroid tissue (whether 1 gland or more than 1 gland)

• Image to LOCALIZE; inform surgeon's choice of operation

#ASNR20

Two accepted operative strategies:

1) bilateral neck exploration (BNE) - original operation, involves surgeon's inspection of all parathyroid glands → removal of glands judged abnormal

#ASNR20

2) minimally invasive parathyroidectomy (MIP) - newer operation; generally preferred when appropriate; SINGLE GLAND removed; PREREQUISITE - confident and precise preoperative localization of single adenoma

#ASNR20

To select the correct operation, surgeon wants to know:

• number, size, and location of candidate lesions

• your opinion of what each candidate lesion represents

#ASNR20

Re: location, I describe with respect to TE groove (AP) and cricoid cartilage (SI). TE groove informs embryologic origin and operative risk to RLN. Cricoid cartilage consistently palpable, visualized in standard operative field, and orients surgeon to anatomic midline. #ASNR20

Also important to notify the surgeon of:
• concurrent thyroid pathology
• arterial anomalies associated with 'nonrecurrent' laryngeal nerve (most often aberrant right subclavian; also right aortic arch with aberrant left subclavian)

#ASNR20

By accurately reporting what the surgeons need to know from 4D CT, we facilitate the best possible operative plan for each patient.

#ASNR20

Sincere thanks to my mentors, colleagues, and collaborators Drs. Hillary Kelly (@hillaryrkelly), George Hunter, Greg Randolph, Reese Randall (@ReeseRandle), Hafiz Patwa, and Valerie George.

There is much additional important info I was unable to cover in this brief talk. Interested in learning more about performing and interpreting parathyroid 4D CT? Consider keeping an eye out for our @RadioGraphics article slated for the September 2020 issue.

#ASNR20 @TheASNR