Four-dimensional computed tomography for the detection of parathyroid adenomas: diagnostic accuracy and clinical applications

Rolando Cocio, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
Daniela Barahona, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
Joaquín Cristi, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana – Universidad del Desarrollo, Santiago, Chile
Fernanda Blaskovic, Departamento de Imágenes, Facultad de Medicina, Clínica Alemana – Universidad del Desarrollo, Santiago, Chile

Primary hyperparathyroidism is diagnosed by laboratory abnormalities, and in up to 80% of cases it results from a solitary adenoma, which can lead to complications affecting the cardiovascular system, kidneys, and bones. The only cure is excision of the gland, with minimally invasive surgery being the standard of care. A precise and high-quality preoperative imaging technique is essential. Scintigraphy, ultrasound, computed tomography (CT) and magnetic resonance imaging are the most common techniques used. There is no consensus on the optimal diagnostic imaging algorithm; however, a CT protocol known as 4D CT has emerged as a highly accurate and widely available alternative among centers in our country. We conducted a literature review of the parathyroid 4D CT technique, emphasizing the protocol characteristics and the appropriate diagnostic analysis for the preoperative localization of adenomas in patients with hyperparathyroidism, accompanied by illustrative cases from our experience.

Keywords: Computed tomography. Contrast medium. Diagnostic imaging. Primary hyperparathyroidism. Parathyroid neoplasms. Parathyroidectomy.