Role of the parathyroid gland vascularization index in predicting percutaneous ethanol injection efficacy in refractory uremic hyperparathyroidism.
OBJECTIVE
To evaluate the role of the quantitative vascularization index (VI) as a measure of the completeness of percutaneous ethanol injection therapy (PEIT).


METHODS
A total of 37 dialysis patients with secondary hyperparathyroidism refractory to medical therapy received PEIT. We analyzed the role of a quantitative marker of parathyroid adenoma activity, i.e. VI, flow index and vascular flow index as measured by 3-dimensional Doppler ultrasound with a 3-dimensional histogram software, for all patients before treatment and at 1 month and 6 months after PEIT.


RESULTS
Serum intact parathyroid hormone (i-PTH) level showed a strong positive correlation with the VI both before (p < 0.001) and after (p < 0.001) PEIT. There was no correlation between i-PTH level and the volume of the gland either before (p = 0.697) or after (p = 0.564) PEIT. One month after PEIT, 20 patients (group 1) reached the target of i-PTH ≤ 300 pg/ml and 17 patients (group 2) did not. Group 2 patients had significantly greater VI and i-PTH prior to PEIT than group 1 patients (42.23 ± 8.38 vs. 14.95 ± 8.07, p <0.001 and 1,447 ± 243 vs. 859 ± 231, p < 0.001 respectively).


CONCLUSIONS
A higher VI indicates a higher i-PTH, and the VI may be a reliable predictor of the completeness of PEIT.
Chen
Han-Hsiang
HH
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, ROC. lincj@ms1.mmh.org.tw
Lu
Kuo-Cheng
KC
Lin
Cheng-Jui
CJ
Wu
Chih-Jen
CJ
D002908:Chronic Disease; D003956:Dialysis / Q000009:adverse effects*; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007279:Injections, Subcutaneous; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014463:Ultrasonography; D014511:Uremia / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology
D000431:Ethanol