The Role of Computed Tomography for Localization of Parathyroid Adenomas

OBJECTIVE/HYPOTHESIS: The purpose of this study was to evaluate the use of computed tomography (CT) for localization of parathyroid adenomas (PA) when first-line imaging is indeterminate. STUDY DESIGN: Retrospective case series. METHODS: A search of operating room and radiology records identified 223 surgical explorations for primary hyperparathyroidism. Adenoma locations on CT, ultrasound, and nuclear scintigraphy were correlated with an independent review of operative records. RESULTS: The presence of adenoma in the correct side and quadrant of the neck was predicted by CT in 89% and 77% of studies, respectively. When first-line studies were indeterminate, the positive predictive value of CT for localization of PA to the correct side and quadrant of the neck was 87% and 69%, respectively. CONCLUSIONS: When first-line localization studies are indeterminate in patients with primary hyperparathyroidism, CT is a valuable, rapid, and widely available imaging modality that can be used to localize PA.