Localization of parathyroid adenoma by computed tomography

Diagnostic advances in APUDomas and other endocrine tumors: imaging and localization

The different diagnostic imaging modalities available for determining the location of the various APUDomas are discussed with reference to their advantages and disadvantages. The ability to image these lesions, and to be confident in their role in the underlying pathophysiology, and clinical neuroendocrine syndrome causing symptomatology and illness, has proved to be the key to successful treatment. In many instances it is not the diagnosis that is in question, but it is the extent of disease, the location of the lesion, or whether the anatomical abnormality under study is responsible for the complicating symptoms being considered, that are the crucial questions. The ability to locate APUDomas by a variety of direct and indirect imaging or regionalizing modalities, represent a magnificent advance in the management of these tumors. It should, however, be kept in mind that no one modality or diagnostic method can uniformly be relied upon. It is evident that a multimodal, interactive medical team approach is essential to the successful overall management of patients afflicted with these fascinating tumors.

Parathyroid adenomas; computed tomographic imaging and the importance of preoperative localization

Contrary to what is frequently stated in the literature, preoperative localization of parathyroid adenomas is important. Surgery limited to removal of the adenoma is associated with significantly less morbidity than when bilateral exploration is undertaken. In fact, a 2 to 12 fold decrease in post-operative hypocalcemia has been reported when the surgical exploration is unilateral. Pre-operative CT scans localized 10 of 13 surgically proven adenomas for an overall detection rate of 77%. Only one adenoma in our series had an average axial diameter of greater than 1 cm, the smallest measuring 5 mm X 3 mm. This paper outlines our CT technique and results and summarizes the pertinent recent surgical literature in reference to the importance of preoperative localization.