Diagnosis of Parathyroid Adenomas with New Ultrasound Imaging Modalities


  • Ultrasound technology:
    • Is becoming an integral part of diagnosing parathyroid adenomas
    • Careful ultrasound evaluation with:
      • B-mode
      • Shear wave elastography
      • Three-dimensional (3D) of parathyroid adenomas:
        • May improve localization and outcome
  • Introduction:
    • A 60-year-old woman was referred for the evaluation of hyperparathyroidism.
    • This patient gave her informed consent.
    • She had a history of hypothyroidism and thyroid nodules.
    • She was being treated with levothyroxine 50 mcg daily.
    • Routine testing revealed hypercalcemia:
      • The serum calcium was 11.2 (nL range 8.7–10.2 mg/dL), creatinine was 0.69 (nL range 0.57–1.00 mg/dL), intact parathyroid hormone (PTH) was 70 (nL range 15–65 pg/mL), phosphorus was 2.7 (nL range 2.5–4.5 mg/ dL), vitamin D was 38.7 (30–100 ng/mL), and 24 hours urine calcium was 362.9 (100–300 mg/24 hour).
    • The neck ultrasound showed:
      • Two lesions one superior/posterior and the other in the inferior/posterior aspect of the right thyroid lobe measuring 11.6 · 4.4 · 9.7 mm and 14.6 · 5.0 · 10.0 mm, respectively.
      • Both lesions resembled parathyroid adenomas.
      • Shear wave velocity (SWV) measurements for the superior and inferior lesions were 1.67 and 1.77 m/second, respectively.
      • For the adjacent thyroid tissue SWV was 2.3 m/second, significantly higher.
      • 3D ultrasound examination demonstrated a polar artery in both lesions.
    • A sestamibi scan showed a probable right parathyroid adenoma and she was referred for surgery.
    • She was found to have two right parathyroid adenomas in the superior and inferior poles corresponding with the ultrasound finding.
    • Intraoperative PTH level decreased from 139.9 to 17 pg/mL postresection.
    • Six weeks after surgery, her calcium and PTH were normal.
  • Materials and Methods:
    • This patient was evaluated with ultrasound imaging, including:
      • B- mode
      • Shear wave elastography (SWE)
      • 3D ultrasound

Parathyroid Adenoma Ultrasound

  • Discussion:
    • Most patients with primary hyperparathyroidism have a single parathyroid adenoma:
      • Other causes include:
        • Glandular hyperplasia
        • Multiple adenomas
        • Parathyroid carcinoma
    • The role of ultrasound in diagnosing parathyroid adenomas:
      • Is becoming more prominent because of:
        • Improved technology
        • Low cost
        • Noninvasive nature
    • SWE can be an added value to b-mode ultrasound in diagnosing parathyroid adenomas:
      • Previous publications have reported that SWV measurement of parathyroid adenomas:
        • May enhance other sonographic parameters to predict the diagnosis of parathyroid adenomas:
          • Parathyroid adenomas appear to have:
            • A more homogenous texture when compared with the thyroid gland
            • Lower tissue stiffness when compared with the thyroid gland
    • It can be challenging to differentiate:
      • Parathyroid adenomas from lymph nodes (LNs) and ectopic thyroid tissue at level VI, with b-mode ultrasound
      • A combination of 3D ultrasound images with 3D color Doppler (CD):
        • Might improve our ability to:
          • Identify the polar artery and enhance differentiation from LN
      • 3D technology might improve the view:
        • By adding coronal view to current b-mode that comprises of transverse and longitudinal views
  • Conclusion:
    • Combining multiple image modalities, including:
      • B-mode, shear wave elastography, and 3D technology:
        • May improve our ability to identify parathyroid adenomas.
    • Parathyroid adenomas have:
      • A lower SWV compared with thyroid tissue
    • 3D ultrasound technology may enhance view of the polar artery when adding 3D CD. 




#Hiperparatiroidism #Hipercalcemia






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