Contrast-enhanced ultrasonography (CEUS) using early dynamic in microcirculation for localization of pathological parathyroid glands: first-line or complimentary diagnostic modality?
BACKGROUND
Contrast-enhanced ultrasonography (CEUS) represents a new diagnostic tool to localize pathological parathyroid glands. The aim of this study was to differentiate the capability of CEUS as first-line or complimentary modality for the detection of hyperfunctioning parathyroid glands.


METHODS
Sixty patients with pHPT were admitted to the University Hospital Regensburg between 8/2009 and 3/2011. Conventional and contrast-enhanced ultrasonography (CEUS) using a linear probe (6-9 MHz, LOGIQ E9/GE) was performed in all patients preoperatively. The sensitivity of CEUS was analyzed to determine its potential as first line or complimentary diagnostic procedure.


RESULTS
Using CEUS 98.3% of all pathological glands could be detected in the correct quadrant whereas conventional ultrasonography (70%) (p < 0.001) revealed less sensitivity. In all patients CEUS indicated a correct side localization of the hyperfunctioning parathyroid gland. The advantage of CEUS was the detection of the early dynamic on the capillary level immediately after contrast injection. Overall, CEUS permit minimally invasive video-assisted parathyroidectomy in 45 patients. 15 patients required conventional procedure due to concomitant goiter. All patients showed normal calcium and parathyroid hormone serum levels three months after surgery.


CONCLUSIONS
CEUS represents a highly sensitive diagnostic modality for localization of pathologic parathyroid glands in patients with pHPT. Nevertheless, it can only be recommended as first-line diagnostic procedure in specialized clinical centers with experienced investigators.
Department of Surgery, University Hospital Regensburg, Regensburg, Germany. matthias.hornung@klinik.uni-regensburg.de
Matthias
M
Hornung
Ernst Michael
EM
Jung
Christian
C
Stroszczynski
Hans J
HJ
Schlitt
Ayman
A
Agha
D000236:Adenoma / Q000097:blood / Q000098:blood supply* / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002118:Calcium / Q000097:blood; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D006042:Goiter / Q000150:complications / Q000601:surgery; D006801:Humans; D006961:Hyperparathyroidism / Q000209:etiology; D008102:Liver Circulation; D008297:Male; D045423:Microbubbles; D008833:Microcirculation; D010281:Parathyroid Hormone / Q000097:blood; D010282:Parathyroid Neoplasms / Q000097:blood / Q000098:blood supply* / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods; D010743:Phospholipids; D011300:Preoperative Care / Q000379:methods*; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional / Q000379:methods*; D020535:Video-Assisted Surgery / Q000379:methods
D003287:Contrast Media; D010281:Parathyroid Hormone; D010743:Phospholipids; C420843:contrast agent BR1; D002118:Calcium; D013459:Sulfur Hexafluoride