| Autor: |
Pavlovics S; Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia.; Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia., Radzina M; Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia.; Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia.; Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia., Niciporuka R; Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia.; Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia., Ratniece M; Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia.; Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia., Mikelsone M; Department of Statistics, Riga Stradins University, LV-1007 Riga, Latvia., Tauvena E; Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia., Liepa M; Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia.; Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia., Prieditis P; Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia.; Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia., Ozolins A; Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia.; Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia., Gardovskis J; Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia.; Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia., Narbuts Z; Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia.; Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia. |
| Abstrakt: |
Background and Objectives : preoperative differentiation of enlarged parathyroid glands may be challenging in conventional B-mode ultrasound. The aim of our study was to analyse qualitative and quantitative characteristics of parathyroid gland lesions, using multiparametric ultrasound protocol-B-mode, Colour Doppler (CD), and contrast-enhanced ultrasound (CEUS)-and to evaluate correlation with morphology in patients with hyperparathyroidism (HPT). Materials and Methods : consecutive 75 patients with 88 parathyroid lesions and biochemically confirmed HPT prior to parathyroidectomy were enrolled in the prospective study. B-mode ultrasound, CD, and CEUS were performed with the subsequent qualitative and quantitative evaluation of acquired data. We used 1 mL or 2 mL of intravenous ultrasound contrast agent during the CEUS examination. Correlation with post-surgical morphology was evaluated. Results: seventy parathyroid adenomas were hypoechoic and well contoured with increased central echogenicity (44.3%), peripheral-central vascularization (47%), and polar feeding vessel (100%). Twelve hyperplasias presented with similar ultrasound appearance and were smaller in volume ( p = 0.036). Hyperplasias had a tendency for homogenous, marked intense enhancement vs. peripherally enhanced adenomas with central wash-out in CEUS after quantitative analysis. No significant difference was observed in contrasting dynamics, regardless of contrast media volume use (1 mL vs. 2 mL). We achieved 90.9% sensitivity and 72.7% specificity, 93% positive predictive value (PPV), 87.3% negative predictive value (NPV), and 87.3% accuracy in the differentiation of parathyroid lesions prior to post-processing. In a quantitative lesion analysis, our sensitivity increased up to 98%, specificity 80%, PPV 98%, and NPV 80% with an accuracy of 96.4%. Conclusions: CEUS of parathyroid lesions shows potential in the differentiation of adenoma from hyperplasia, regardless of the amount of contrast media injected. The quantitative analysis improved the sensitivity and specificity of differentiation between parathyroid lesions. Hyperplasia was characterized by homogeneous enhancement, fast uptake, and homogeneous wash-out appearance; adenoma-by peripheral uptake, central wash-out, and reduced hemodynamics. The use of CEUS quantification methods are advised to improve the ultrasound diagnostic role in suspected parathyroid lesions. |
