title: Highly efficient localization of pathological glands in primary hyperparathyroidism using contrast-enhanced ultrasonography (CEUS) in comparison with conventional ultrasonography.
abstract: BACKGROUND
  Preoperative detection of parathyroid gland adenoma in the presence of primary hyperparathyroidism (pHPT) represents a diagnostic challenge. We present the first prospective study with contrast-enhanced ultrasonography (CEUS) as the central diagnostic tool for the preoperative localization of parathyroid gland adenoma in pHPT in comparison with conventional ultrasonography.
  
  
  METHODS
  Between July 2010 and December 2011, 75 consecutive patients underwent surgery for pHPT. In all patients, conventional ultrasonography and CEUS were performed prospectively for localization of pathological parathyroid glands. Twenty-five patients suffered from a concomitant goiter (CG), and 12 patients had undergone previous neck surgery due to thyroid pathologies. The sensitivity of both diagnostic tools was analyzed in comparison with intraoperative and histological findings.
  
  
  RESULTS
  CEUS had a sensitivity of 97% for the detection of the correct quadrant of the pathological parathyroid gland and of 99% for the correct side in comparison with 70% for conventional ultrasonography. In multivariate regression analysis, CG, gland size, and body mass index had a relevant impact on incorrect findings by conventional ultrasonography as compared with CEUS. Follow-up with a minimum of 6 months after surgery showed normal serum levels of calcium and PTH in all 75 patients.
  
  
  CONCLUSIONS
  CEUS represents a highly reliable, noninvasive and nonradioactive diagnostic tool for localization of pathological parathyroid glands in patients with pHPT. Even in the presence of CG, previous neck surgery, or double adenomas, CEUS has a high sensitivity.
authors.affiliation: Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany. Ayman.agha@klinik.uni-regensburg.de
authors.forename: Ayman
authors.initials: A
authors.lastname: Agha
authors.forename: Matthias
authors.initials: M
authors.lastname: Hornung
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Schlitt
authors.forename: Ernst Michael
authors.initials: EM
authors.lastname: Jung
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000150:complications; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D010280:Parathyroid Glands / Q000000981:diagnostic imaging* / Q000473:pathology; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D047368:Tumor Burden; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D003287:Contrast Media