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Presurgical Localization of Parathyroid Adenomas with Magnetic Resonance Imaging at 3.0 T: An Adjunct Method to Supplement Traditional Imaging

  • Endocrine Tumors
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Abstract

Purpose

To investigate the use of a chemical shift-based water–fat separation magnetic resonance imaging (MRI) method, and time-resolved contrast-enhanced MRI at 3 T for improved presurgical localization of parathyroid adenomas.

Methods

Twenty-five patients with primary hyperparathyroidism were prospectively enrolled. Patients underwent MRI, which was reviewed by two experienced neuroradiologists who were blinded to Tc-99m sestamibi imaging and operative results.

Results

Overall, MRI detected 16 adenomas in 25 patients (sensitivity 64%, positive predictive value 67%), while sestamibi detected 18 of 25 adenomas (sensitivity 72%, positive predictive value 90%). Importantly, MRI was able to detect adenomas in four (57%) of the seven patients whose disease was missed by sestamibi analysis. MRI demonstrated excellent image quality and fat suppression by using a chemical shift-based water–fat separation technique. The time-resolved MRI was considered to be less helpful, although in some cases it was indispensable.

Conclusions

MRI is an excellent adjunct for preoperative parathyroid localization. The advent of improved fat suppression techniques in the neck, including chemical shift–based water–fat separation, is critical to its utility. Although time-resolved MRI was not always helpful, it was crucial in certain cases. It may prove to be more useful with the development of faster scanning techniques.

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Acknowledgment

The authors thank the internal research and development committee for supplying the funding for the contrast material. One author (SBR) has a family member employed by GE Healthcare. The Department of Radiology at UW-Madison gratefully acknowledges research support from GE Healthcare.

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Authors and Affiliations

  1. Department of Radiology, University of Wisconsin, Madison, WI, USA

    Allison M. Grayev MD, Lindell R. Gentry MD, Michael J. Hartman MD, Scott B. Perlman MD & Scott B. Reeder MD, PhD

  2. Department of Surgery, University of Wisconsin, Madison, WI, USA

    Herbert Chen MD

  3. Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA

    Scott B. Reeder MD, PhD

  4. Department of Medical Physics, University of Wisconsin, Madison, WI, USA

    Scott B. Reeder MD, PhD

  5. Department of Medicine, University of Wisconsin, Madison, WI, USA

    Scott B. Reeder MD, PhD

Authors
  1. Allison M. Grayev MD
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  2. Lindell R. Gentry MD
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  3. Michael J. Hartman MD
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  4. Herbert Chen MD
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  5. Scott B. Perlman MD
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  6. Scott B. Reeder MD, PhD
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Corresponding author

Correspondence to Scott B. Reeder MD, PhD.

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Grayev, A.M., Gentry, L.R., Hartman, M.J. et al. Presurgical Localization of Parathyroid Adenomas with Magnetic Resonance Imaging at 3.0 T: An Adjunct Method to Supplement Traditional Imaging. Ann Surg Oncol 19, 981–989 (2012). https://doi.org/10.1245/s10434-011-2046-z

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  • DOI: https://doi.org/10.1245/s10434-011-2046-z

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