Role of CT in diagnosis and differential diagnosis of primary hyperparathyroidism / 中华内分泌外科杂志

ABSTRACT

Objective To analyze CT characteristics of patients with primary parathyroid hyperplasia ( PPH) , parathyroid adenoma ( PA) , atypical parathyroid adenoma ( APA) , and parathyroid carcinoma ( PC) and to evaluate the value of CT in the diagnosis and differential diagnosis of primary hyperparathyroidism ( PHPT ) . Methods CT scan of 134 pathologically proved PHPT patients with complete clinical and laboratory data were retrorespectively analyzed .The similarities and differences of CT features in patients with PPH , PA, APA and PC were studied.Results Among 140 lesions in the 134 patients, 130 cases had solitary parathyroid mass and 4 cases had 10 parathyroid masses , including 22 lesions in 17 patients with PPH, with the diameter ranging from 0.6 cm to 2.8 cm(1.2 ±0.6)cm, 106 lesions in 105 patients with PA, with the diameter ranging from 0.3 cm to 3.2 cm (1.1 ±0.6)cm, 10 lesions in 10 patients with APA, with the diameter ranging from 0.9 cm to 3.3 cm(2.6 ± 0.6)cm, and 2 lesions in 2 patients with PC, with the diameter ranging from 2.1 cm to 3.0 cm(2.6 ±0.6)cm. 124 lesions were located in tracheo-esophageal groove or at the side of trachea on CT .The boundaries between the parathyroid and thyroid gland were low density .3 lesions did not appear .9 lesions were located at the area over the manubrium sterni among 13 lesions which were ectopic.CT images showed round (29.9%,41/137), oval (38.0%,52/137), triangular(19.7%, 27/137), and cylindrical(12.4%,17/137) tumors in 137 lesions.The density of lesions were 30-66 Hu(45.0 ±12.3)Hu on non-enhanced CT scan, and 59-209 Hu(121.8 ±32.7)Hu on enhanced scan .Different pathological lesions had no statistical difference on location ( left upper , left lower , right upper, right lower, ectopic)(χ2 =15.839), linear low density sign(χ2 =1.896), shape(χ2 =10.945), non-enhanced CT(χ2 =0.915) or enhancement CT(χ2 =6.165)(P>0.05).Different pathological lesions had statistical significance on sizes(χ2 =18.395, P<0.05).The diameter of APA-PC was bigger than that in PH-PA.99 lesions exhibited homogeneous enhancement , and 38 lesions exhibited heterogeneous enhancement .The necrosis rate of APA-PC was more than that of PH-PA(χ2 =7.929, P<0.05).Conclusions The lesions origi-nate from parathyroid if they are located in tracheo-esophageal groove or at the side of trachea with hyperparathy-roidism.Multiple lesions help in PH diagnosis .Large size and necrosis in lesions imply APA or PC .The location (left upper, left lower, right upper, right lower, ectopic), shape, density and the degree of enhancement of the lesions have not specificity for diagnosis of PHPT .