title: Does contrast-enhanced cervical ultrasonography improve preoperative localization results in patients with sporadic primary hyperparathyroidism?
abstract: OBJECTIVE
  Pre-operative localization studies are inevitable in patients with primary hyperparathyroidism (pHPT), who are eligible for focused or minimally invasive parathyroidectomy (MIP). High-resolution ultrasonography (US) in combination with planar (99m)Tc-Sestamibi-scintigraphy (MIBI) and additional single-photon emission computed tomography (SPECT) are the standard procedures to localize enlarged parathyroid glands. Our aim was to evaluate the practicability and significance of contrast-enhanced ultrasonography (CEUS) in patients with pHPT.
  
  
  METHODS
  All investigations were performed at the University Hospital Marburg. Totally, 25 patients with biochemical proven pHPT underwent preoperative US, MIBI/SPECT, and CEUS. For CEUS, a suspension of phospholipid-stabilized sulfur-hexafluoride (SF6) microbubbles in combination with a special 12 MHz linear US probe was used. All patients were investigated by two sonographers, who did not get to view the findings noted by the other. Finally, surgery was performed and histopathological results were obtained from 24 patients.
  
  
  RESULTS
  In 17 (68%) patients, US and MIBI/SPECT already raised suspicion of parathyroid lesions and all suspected lesions were reassessed by CEUS. However, no additional information was obtained using CEUS. Especially in eight patients with negative or inconsistent US and MIBI/SPECT results, CEUS did not provide additional information regarding the site of the suspected parathyroid adenoma. Overall, no side effects were observed using CEUS. Surgical cure was achieved in all patients.
  
  
  CONCLUSIONS
  In this limited cohort of patients, no additional information could be obtained using the costly CEUS compared to results of US and MIBI/SPECT.
authors.affiliation: Department of Visceral, Thoracic and Vascular Surgery, University Hospital Marburg, Germany.
authors.forename: Elias
authors.initials: E
authors.lastname: Karakas
authors.forename: Susanne
authors.initials: S
authors.lastname: Kann
authors.forename: Helmut
authors.initials: H
authors.lastname: Höffken
authors.forename: Detlef Klaus
authors.initials: DK
authors.lastname: Bartsch
authors.forename: Ilhan
authors.initials: I
authors.lastname: Celik
authors.forename: Christian
authors.initials: C
authors.lastname: Görg
authors.forename: Andreas
authors.initials: A
authors.lastname: Pfestroff