Correlation between 4D-CT Enhancement Patterns and Parathyroid Adenoma Cellularity: A Retrospective Study

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ABSTRACT BACKGROUND AND PURPOSE: Four-dimensional computed tomography (4DCT) is a well-established modality for preoperative localization of parathyroid adenomas1-3. However, the relationship between enhancement patterns and histologic features such as lesion cellularity remains unclear. This study evaluates whether enhancement patterns correlate with lesion cellularity in surgically confirmed parathyroid adenomas. MATERIALS AND METHODS: A retrospective cohort study was performed on 134 patients (194 parathyroid lesions) who underwent 4DCT for preoperative localization and subsequent parathyroidectomy. After excluding lesions that were not visualized on 4DCT, not resected, or lacked pathology data on cellularity, 121 lesions in 95 patients were included in the final analysis. Enhancement patterns were categorized into Type A, B, or C based on previously published criteria4. Cellularity was dichotomized into increased and non-increased groups using an 80% cutoff. Mixed effect logistic regression analysis was performed to adjust for potential confounders. RESULTS: Among the 121 lesions with reported enhancement pattern and cellularity, 26 (21.5%) exhibited Type A enhancement, 65 (53.7%) Type B, and 30 (24.8%) Type C. Increased cellularity was observed in 88 lesions (72.7%). Type A enhancement was independently associated with increased cellularity (OR 6.1, 95% CI 1.3-29.3, p=0.02) after adjusting for confounders. Larger lesion size was also a significant predictor of increased cellularity (p<0.001). No significant correlation was found between enhancement category B or C and cellularity. CONCLUSIONS: Type A enhancement on 4DCT is independently associated with increased cellularity in parathyroid adenomas. These findings suggest that enhancement kinetics may serve as a surrogate marker for histologic features, providing additional information for preoperative planning and surgical decision-making. ABBREVIATIONS: 4DCT = four-dimensional contrast-enhanced computed tomography neck; MGD = multi-gland disease; pHPT = primary hyperparathyroidism; PTH = parathyroid hormone; SPECT = single photon emission-computed tomography

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