Value of Neuroradiology Second Reads of CT Scans for Hyperparathyroidism

<b>Background/Objectives</b>: Parathyroidectomy is a curative procedure for primary hyperparathyroidism, and multi-phase CT is an integral part of surgical planning. While patients may be referred to centers specializing in endocrine surgery, their imaging may be performed at other facilities without the same high-volume expertise. <b>Methods</b>: A retrospective review was performed of radiologist second reads of outside neck CT imaging in patients with hyperparathyroidism referred for surgical management. <b>Results</b>: The initial outside report was 59% sensitive for localization of parathyroid adenoma in the 74 patients with surgical pathologic confirmation. Second reads of the same CT scans correctly identified the parathyroid adenoma in an additional 24% of patients, for a total sensitivity of 83%. For the 23% of patients with pathologically confirmed multi-gland involvement, the initial outside report was 21% sensitive for lesion detection, and the second read of the same scans was 68% sensitive. <b>Conclusions</b>: Endocrine surgeons should be aware that community-based radiology interpretation of neck CT may be less sensitive than reported series from academic and high-volume practices. In the present study, interpretation via second read of outside CT scans by a neuroradiologist engaged with the endocrine surgery service line increased the sensitivity of detecting candidate lesions, both for single-gland and multi-gland involvement. While it is preferred to have preoperative imaging and interpretation within the same high-volume center as the surgeon for consistency of imaging quality, experience and communication, radiologist second reads deserve financial and service line support when that is not possible given the impact on surgical planning and patient care.