title: Parathyroid-gland ultrasonography in clinical and therapeutic evaluation of renal secondary hyperparathyroidism.
abstract: OBJECTIVE
  This study evaluated the relationship between ultrasonographic (US) parameters of parathyroid glands (PTGs) in haemodialysis patients (HDP) and degree of secondary hyperparathyroidism (SHPT), therapeutic responsiveness and type of PTG hyperplasia (diffuse or nodular).
  
  
  METHODS
  In 85 HDP, we evaluated the following US parameters of all and of the largest PTGs: number, maximum longitudinal diameter (MLD), structural (hypoechoic, heterogeneous, nodular) and vascular (nonhypovascular, intermediate, hypervascular) echo-pattern scores. Sixty-nine HDP underwent medical therapy (vitamin D, 39; vitamin D/cinacalcet, 30) and 16 underwent parathyroidectomy. The 69 HDP were classified as responders [median intact parathyroid hormone (iPTH) ≤300 pg/ml during follow-up) or nonresponders (iPTH >300 pg/ml).
  
  
  RESULTS
  Number, MLD and structural and vascular echo patterns of PTGs were significantly correlated with iPTH and calcium concentrations. In the 41 (59%) responders, number (0-1), MLD (<10 mm) and structural and vascular scores (1-2) of the largest PTG were significantly lower than in nonresponders. Receiver operating curve (ROC) curve analysis showed high sensitivity and specificity (90% and 73%, respectively) of the MLD (<10mm) of the largest PTG in the predicting therapeutic outcome. US and histological MLD are significantly correlated and predict the type of hyperplasia.
  
  
  CONCLUSIONS
  US parameters of PTGs are correlated to the degree of SHPT and type of hyperplasia and predict responsiveness to medical therapy.
authors.affiliation: Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Roma, Italy. c.vulpio@alice.it
authors.forename: C
authors.initials: C
authors.lastname: Vulpio
authors.forename: M
authors.initials: M
authors.lastname: Bossola
authors.forename: S C
authors.initials: SC
authors.lastname: Magalini
authors.forename: P
authors.initials: P
authors.lastname: Silvestri
authors.forename: G
authors.initials: G
authors.lastname: Fadda
authors.forename: M
authors.initials: M
authors.lastname: Ciliberti
authors.forename: M L
authors.initials: ML
authors.lastname: D'Andrea
authors.forename: G
authors.initials: G
authors.lastname: Maresca
mesh_terms: D015415:Biomarkers / Q000097:blood; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000000981:diagnostic imaging; D016105:Parathyroidectomy; D006435:Renal Dialysis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D015415:Biomarkers; D014807:Vitamin D