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Diagnostic Performance and Inter-Observer Agreement of 4-Dimensional Computed Tomography Parathyroid Scans in Patients with Primary and Secondary Hyperparathyroidism 预览
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作者 Bundhit Tantiwongkosi Frank R. Miller +6 位作者 Viet D. Nguyen Kathleen E. Hands Boyce B. Oliver Alfredo A. Santillan Wilson B. Altmeyer Achint K. Singh Fang Yu 《放射学期刊(英文)》 2019年第1期82-91,共10页
Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robus... Background: 4D-CT has been used to localize the parathyroid adenomas and hyperplasia since 2006 as a second line study after TC-99 m MIBI and ultrasonography. However, multiple studies have shown that 4D-CT is a robust imaging method with high diagnostic accuracy, becoming increasingly popular among surgeons and radiologists. Purpose: To assess the diagnostic performance of 4D-CT scans to identify the pathologic gland(s), using pathology and intraoperative findings as gold standards. Methods: We analyzed patients with primary and secondary hyperparathyroidism who had intraoperative reports, pathology, parathyroid hormone levels, and preoperative 4D-CT. Histology, surgical findings, and decreased parathyroid hormone levels were used as gold standards. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and 95% confidence interval were calculated. Fleiss’ kappa was used to assess the inter-observer agreement. Results: Sixty-seven patients were included. Sixty-two patients had a single adenoma, and five patients had a multiple gland disease (adenomas or hyperplasia). A total of 72 glands were proven to have parathyroid adenomas or hyperplasia. The sensitivity, specificity, PPV, NPV and accuracy are 85%, 97%, 96%, 87% and 91% for lateralization and 76%, 96%, 85%, 92% and 90% for quadrant localization, respectively in single-gland disease. The sensitivity, specificity, PPV, NPV and accuracy are 88%, 100%, 100%, 50% and 90% for lateralization and 71%, 100%, 100%, 60% and 80% for quadrant localization respectively in multiple-gland disease. Fleiss’ kappa value is 5.6 (moderate inter-observer agreement). Conclusion: 4D-CT is a robust method in the localization of hyperfunctioning parathyroid glands with high accuracy and at least moderate inter-observer agreement. 展开更多
关键词 COMPUTED TOMOGRAPHY PARATHYROID 4-Dimensional HYPERPARATHYROIDISM
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Role of ~(18)F-FDG PET/CT in pre and post treatment evaluation in head and neck carcinoma 预览 被引量:1
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作者 Bundhit Tantiwongkosi Fang Yu +1 位作者 Anand Kanard Frank R Miller 《世界放射学杂志:英文版(电子版)》 2014年第5期177-191,共15页
Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced d... Head and neck cancer(HNC) ranks as the 6th most common cancer worldwide, with the vast majority being head and neck squamous cell carcinoma(HNSCC). The majority of patients present with complicated locally advanced disease(typically stage Ⅲ and Ⅳ) requiring multidisciplinary treatment plans with combinations of surgery, radiation therapy and chemotherapy. Tumor staging is critical to decide therapeutic planning. Multiple challenges include accurate tumor localization with precise delineation of tumor volume, cervical lymph node staging, detection of distant metastasis as well as ruling out synchronous second primary tumors. Somepatients present with cervical lymph node metastasis without obvious primary tumors on clinical examination or conventional cross sectional imaging. Treatment planning includes surgery, radiation, chemotherapy or combinations that could significantly alter the anatomy and physiology of this complex head and neck region, making assessment of treatment response and detection of residual/ recurrent tumor very difficult by clinical evaluation and computed tomography(CT) or magnetic resonance imaging(MRI). 18F-2-fluoro-2-deoxyD-glucose positron emission tomography/CT(18F-FDG PET/CT) has been widely used to assess HNC for more than a decade with high diagnostic accuracy especially in detection of initial distant metastasis and evaluation of treatment response. There are some limitations that are unique to PET/CT including artifacts, lower soft tissue contrast and resolution as compared to MRI, false positivity in post-treatment phase due to inflammation and granulation tissues, etc. The aim of this article is to review the roles of PET/CT in both pre and post treatment management of HNSCC including its limitations that radiologists must know. Accurate PET/CT interpretation is the crucial initial step that leads to appropriate tumor staging and treatment planning. 展开更多
关键词 Head and NECK cancer POSITRON emission TOMOGRAPHY COMPUTED TOMOGRAPHY STAGING Post treatment Recurrence
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