title: Contrast-enhanced ultrasonography for localization of pathologic glands in patients with primary hyperparathyroidism.
abstract: BACKGROUND
  The localization of enlarged parathyroid glands might, depending on size, histology, and concomitant goiter, be difficult in some patients. In the presented study, contrast-enhanced ultrasonography (CEUS) was applied as a new diagnostic tool to detect the site of parathyroid lesions.
  
  
  METHODS
  Thirty patients underwent operation for primary hyperparathyroidism (pHPT) between 8/2009 and 6/2010. Contrast-enhanced ultrasonography (CEUS) using a linear probe (6-9 MHz, LOGIQE9/GE), fundamental B scan, and Doppler ultrasonography, (99m)Technetium-sestamibi scintigraphy and magnetic resonance imaging (MRI) were performed in all patients preoperatively. The diagnostic sensitivity of the procedures, time requirements, and overall costs were analyzed.
  
  
  RESULTS
  Using CEUS, all 31 pathologic glands could be detected, compared with 23 using conventional ultrasonography, 25 using (99m)Technetium-sestamibi scintigraphy and 22 using MRI (P = .015). Costs and time requirement were less using CEUS as compared with (99m)Technetium-scintigraphy and MRI examinations (P = .002). Minimally invasive, video-assisted parathyroidectomy could be performed successfully based on CEUS findings in all but 7 patients who required concomitant thyroid surgery or had underwent previous thyroid operations. All patients showed normal serum levels of calcium and parathyroid hormone serum levels 3 months after parathyroidectomy.
  
  
  CONCLUSIONS
  CEUS represents a highly sensitive and cost-efficient method for localization of pathologic parathyroid glands in patients with pHPT. Future studies should confirm these findings in order to establish CEUS as a standard diagnostic procedure.
authors: Department of Surgery, University Hospital Regensburg, Germany. ayman.agha@klinik.uni-regensburg.de
authors: Ayman
authors: A
authors: Agha
authors: Matthias
authors: M
authors: Hornung
authors: Janine
authors: J
authors: Rennert
authors: Wibke
authors: W
authors: Uller
authors: Hamid
authors: H
authors: Lighvani
authors: Hans J
authors: HJ
authors: Schlitt
authors: Ernst Michael
authors: EM
authors: Jung
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging*; D006965:Hyperplasia / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging; D010743:Phospholipids; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D013459:Sulfur Hexafluoride; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
chemical_list: D010743:Phospholipids; D019275:Radiopharmaceuticals; C420843:contrast agent BR1; D017256:Technetium Tc 99m Sestamibi; D013459:Sulfur Hexafluoride