Pitfalls of 4D CT Parathyroid Imaging

Four-dimensional CT is now widely used for preoperative localization of parathyroid adenomas, especially in cases in which ultrasound and [99mTc]Tc-sestamibi scans have been nonlocalizing or discordant, as it is a more sensitive and specific study. Although accurate interpretation of 4D CT translates to more successful surgical outcomes, radiologists should be aware of the complexities in interpretation. After briefly reviewing optimal scanning technique and interpretation of 4D CT for parathyroid adenoma detection, this Pictorial Essay illustrates various pitfalls that radiologists face in interpreting 4D CT scans and describes ways to avoid them.