Dynamic Parathyroid Computed Tomography (4DCT) Facilitates Reoperative Parathyroidectomy and Enables Cure of Missed XXXX .

@entity1 @entity3243 @entity459 @entity1373
BACKGROUND: Four-dimensional computed tomography (4DCT) is an emerging imaging modality in the evaluation of @entity459 ( @entity459 ). We assessed the role of 4DCT in @entity1 presenting for reoperative parathyroidectomy. METHODS: A prospective database of @entity1 with persistent or recurrent @entity459 undergoing reoperative parathyroidectomy during the years 2006-2014 was analyzed. @entity1 treated before versus after the advent of 4DCT were compared for operative eligibility, operative success, operative time, and concordance of imaging results with surgical findings. RESULTS: Ninety @entity1 were included in the study (61 before 4DCT, 29 after 4DCT). The post-4DCT group had a higher rate of surgical concordance with imaging results (63 vs. 90  %, p  <  0.01) and shorter operative time (114 vs. 76  min, p  <  0.05). The operative success rate was not different (87 vs. 86 %). A similar pattern was observed in the subset of sestamibi-negative @entity1 , with post-4DCT @entity1 having a higher rate of surgical concordance (12 vs. 83  %, p  <  0.0001) and shorter operative time (181 vs. 89  min, p  <  0.05). Among @entity1 ultimately found to have @entity3243 , 4DCT correctly identified multiple enlarged glands in 80  % (4 of 5) and correctly lateralized one or more glands in 100  % (5 of 5) of cases, facilitating successful subtotal parathyroidectomy in the reoperative setting. CONCLUSIONS: 4DCT enables successful and efficient reoperative parathyroidectomy. These benefits extend to difficult cases, including sestamibi-negative @entity1 and those with missed @entity1373 .
