Ultrasonography in detection of single and multiple abnormal parathyroid glands in primary hyperparathyroidism: comparison with radionuclide scintigraphy and surgery. Clin Endocrinol (Oxf)

Endocrinology and Metabolism, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Clinical Endocrinology (Impact Factor: 3.46). 09/2006; 65(3):340-5. DOI: 10.1111/j.1365-2265.2006.02601.x
Source: PubMed


Among the parathyroid imaging techniques, ultrasonography (USG) has the advantage of convenience, easy availability and low cost.
To study the role of USG in localization (side and/or site) of abnormal parathyroid glands in primary hyperparathyroidism (PHPT) and to compare with radionuclide scintigraphy and the 'gold standard', surgery.
Forty-six consecutive patients undergoing USG of the anterior neck for a diagnosis of PHPT in whom a nuclear scan (technetium-99m sestamibi and/or thallium-201/technetium-99m pertechnetate scintigraphy) was also performed, were studied. The results of imaging were independently interpreted and correlated with reference to surgical findings.
Forty-six patients had 52 abnormal parathyroid glands on surgical exploration and surgery was successful in all but one. Forty-one patients had a single adenoma, four had multigland disease and one had a paraganglioma. USG correctly localized the abnormal gland in 30 (73%) and scintigraphy was positive in 40 (98%) out of 41 patients with a single adenoma as confirmed on surgical exploration. Scintigraphy showed a positive concordant test in all 30 patients with a single abnormal gland detected on USG and picked up 10 out of 11 abnormal glands where USG was negative. The sensitivity and positive predictive value of USG for detecting a single abnormal gland was 73% and 100%, respectively, whereas the sensitivity and positive predictive value for scintigraphy was 98%. In patients with multigland disease, USG missed 3 (30%) out of 10 and scintigraphy missed 6 (60%) out of 10 abnormal parathyroid glands as confirmed on surgical exploration (P < 0.05). However, in two patients who had ectopic parathyroid gland, both the modalities localized the lesion in one (paraganglioma), whereas in the other neither test was helpful (left retro-esophageal).
USG is a convenient, affordable and useful modality to localize abnormal enlarged parathyroid glands in the majority of patients with PHPT. However, when USG is negative, scintigraphy is complementary to it.

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Available from: Shariq Masoodi, Apr 21, 2015
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    • "Effectiveness of surgical procedure is highly dependent on precise preoperative localization of lesions. A 99mTc-MIBI SPECT and neck ultrasound examination are approved as standard procedures for localizing abnormal parathyroid glands [6,7]. Sensitivity of ultrasound combined with scintigraphy in detecting single parathyroid adenomas reaches 95 percent [8,9], while in SHPT there are discrepancies in reported sensitivity of scintigraphy – it varies from 25 to 74 percent, which is much lower than in PHPT [9–12]. "
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    ABSTRACT: Secondary hyperparathyroidism is a frequent complication of chronic renal failure. Patients resistant to pharmacotherapy are candidates for parathyroidectomy. Invasiveness of surgical treatment can be minimized by precise preoperative localization of parathyroid glands. Imaging modalities routinely used for this purpose are ultrasonography and MIBI-Tc99m scintigraphy. Our case report shows advantages of co-registered computer tomography and conventional SPECT imaging (SPECT/CT) in a patient with advanced secondary hyperparathyroidism successfully treated with surgery. Hybrid SPECT/CT parathyroid imaging enables better surgical planning and is superior to conventional scintigraphy.
    Full-text · Article · Apr 2013 · Polish Journal of Radiology
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    • "In patients with multi-gland disease, US appeared superior to SS (70% vs. 40%) [8] [16]. Levy et al. has reported that US has the same sensitivity and specificity as SS and the ability to detect concomitant thyroid pathology [13]. "
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    ABSTRACT: Objective: To evaluate and compare the diagnostic performances of high-resolution ultrasonography and (99m)Tc-sestamibi scintigraphy for the preoperative localization of abnormal parathyroid glands and to evaluate the ability of US for additional diagnostic roles in detecting thyroid malignancy in patients with pHPT. Materials and methods: Preoperative localization images of 115 parathyroid adenomas from high-resolution ultrasonography (US) and (99m)Tc-sestamibi scintigraphy (SS) were studied from 105 patients, who had undergone parathyroidectomy. Sensitivity, accuracy, and positive predictive value were calculated for the identification of adenomas in lesions and patients for both US and SS, respectively, and US and SS diagnostic performances were compared using generalized estimating equation. Results: Preoperative imaging by both modalities localized 105 (93.8%) of the 112 parathyroid lesions confirmed at surgery and histology. Sensitivity, accuracy, and positive predictive value were 93.1% and 92.2%, 90.4% and 89.5%, and 96.9% and 96.9% by US and SS, respectively, without any statistically significant differences (P=0.796, 0.796, 0.879). US found incidental thyroid nodules in 47 patients (47/107, 43.9%), and 7 patients (7/107, 6.5%) were confirmed to have malignancy based on pathology results (all had papillary thyroid carcinoma). Conclusion: Neck ultrasonography and (99m)Tc-sestamibi scintigraphy are complementary methods of the preoperative localization of parathyroid adenomas. Neck ultrasounds add an additional thyroid gland evaluation, and can be useful in the detection of incidental thyroid gland lesions, especially malignant nodules.
    Full-text · Article · Aug 2012 · European journal of radiology
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    • "Methyl isobutyl isonitrile (MIBI) scan positivity has been reported in 86.9–100% [12, 17]. Figure 3(b) reveals an MIBI-scan image of a right inferior parathyroid adenoma in one of our patients. Thallium-201 Technetium-99 pertechnetate subtraction has been reported to have a sensitivity of 87–100% [6, 12, 17]. Contrast-enhanced computerized tomography (CECT) of the neck has a sensitivity ranging from 65% to 93.5% in localizing parathyroid adenoma [6, 9, 12]. "
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    ABSTRACT: Primary hyperparathyroidism (PHPT) has become an asymptomatic disease in the Western world with the introduction of routine calcium screening. However, the same phenomenon is not observed in India. We have now systematically reviewed the status of PHPT in India. While there is a paucity of literature on PHPT from India when compared to Western countries, some information can be gleaned upon. Most patients present with symptomatic disease whereas very few are screen-detected cases (bone disease 77%, renal disease 36%, and 5.6% asymptomatic). Mean calcium, parathyroid hormone (PTH), and alkaline phosphate levels are high while Vitamin D levels are low. The average parathyroid gland weight is large and the majority being parathyroid adenomas (89.1%). Hungry bone syndrome (HBS) is common in the postoperative period. The disease-related mortality rate is 7.4%, recurrence 4.16%, and persistent disease 2.17%. We suggest that dedicated efforts are needed to pick up asymptomatic disease in India by methods like incorporating calcium estimation in the routine health check-up programs.
    Full-text · Article · May 2011 · International Journal of Endocrinology
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