Purpose
“The only localization study needed in a patient with hyperparathyroidism is to localize an experienced parathyroid surgeon” is an old saying by Doppman.(1) However,
in the era of minimally invasive surgeries which have far less morbidity and equal success rate,
accurate pre-operative localization of the parathyroid lesion has become extremely important.(2,3)
Ultrasound and Tc99m Sestamibi scinitigraphy are the imaging modalities of choice for pre-operative localization of the parathyroid lesion.
(1,2,4) But these modalities are fraught with significant false positive and false negative rates upto 30%....
Methods and materials
This is an IRB approved prospective study.
Consecutive patients with primary hyperparathyroidism planned for parathyroid surgery and patients with solid thyroid nodules planned for thyroidectomy were recruited into the study after informed consent.
After B-mode ultrasound and colour Doppler,
ARFI elastography was performed on the solid or mixed solid and cystic parathyroid lesions and predominantly solid thyroid nodules.
Thyroid and parathyroid nodules withextensive calcification and predominantly cystic lesions were excluded.
Shear wave elastography using ARFI technology was performed using 9 MHz linear probe of Seimens...
Results
There were 39 solitary adenomas,
2 double adenomas,
3 parathyroid hyperplasias in 43 patients (20 male,
23 females) with age of 41.7 +/- 11.6 years; serum corrected calcium and PTH was 11.12 +/- 1.02 mg/dL and 417.7 +/- 444.1 ng/L respectively; size and weight was20 +/- 9.74 mm (range of 11 – 48 mm)and198.9 +/- 255.8 mg (range of 47-1032 mg)respectively.
ARFI elastography was performed on 102 thyroid nodules and surgical histopathology was available for 93 of them (23 males and 70 females).
Out of...
Conclusion
1.
Our study shows low shear wave velocity in parathyroid lesions compared to thyroid and majority (> 95%) of parathyroid lesions shows elasticity score of 1 or 2.
This is in contrast to previous workers who have used strain elastography.
(11)
2.
Speckled appearance characteristically seen in parathyroid lesions can be used as a sign to differentiate parathyroid and thyroid lesions with high degree of accuracy.
3.
ARFI elastography can be used as an additional tool to increase the accuaracy of ultrasound localisation of parathyroid...
Personal information
Principal investigator:
Dr.
Anuradha Chandramohan,
DMRD,
DNB,
MD,
FRCR
Department of Radiology
Christian Medical College
Vellore,
India – 632004.
[email protected]
Co-investigators:
1.Deepak Abraham MS,
PhD
Professor of Endocrine Surgery
Christian Medical College
Vellore – 632004
[email protected]
2.Marie Therese MD
Professor of Pathology
Christian Medical College
Vellore – 632004
[email protected]
3.Thomas V PaulMD,
DNB
Professor of Endocrinology
Christian Medical College
Vellore – 632004
[email protected]
References
1.
Doppman JL,
Miller DL.
Localization of parathyroid tumors in patients with asymptomatic hyperparathyroidism and no previous surgery.
J Bone Miner Res Off J Am Soc Bone Miner Res.
1991 Oct;6 Suppl 2:S153–8; discussion S159.
2.
Johnson NA,
Tublin ME,
Ogilvie JB.
Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism.
AJR Am J Roentgenol.
2007 Jun;188(6):1706–15.
3.
Kebapci M,
Entok E,
Kebapci N,
Adapinar B.
Preoperative evaluation of parathyroid lesions in patients with concomitant thyroid disease: role of high resolution ultrasonography...