Shear Wave Elastography versus Strain Elastography in Diagnosing Parathyroid Adenomas

Abstract

Objectives. e aim of the study was to compare elastographic means in parathyroid adenomas, using shear wave elastography and strain elastography. Methods. is prospective study examined 20 consecutive patients diagnosed with primary hyperparathyroidism and parathyroid adenoma, confirmed by biochemical assay, technetium-99 sestamibi scintigraphy, and pathology report, after parathyroid surgery. All patients were examined on conventional 2B ultrasound, 2D shear wave elastography, and strain elastography. We determined using 2D shear wave elastography (SWE) the elasticity index (EI) in parathyroid adenoma, thyroid parenchyma, and surrounding muscle and examined using strain elastography the parathyroid adenoma, and determined the strain ratio with the thyroid tissue and muscle tissue. Results. All patients had positive sestamibi scintigraphy and underwent surgery, with confirmation of parathyroid adenoma in all cases. e mean parathormone (PTH) value before surgery was 153.29 pg/ml (36.5, 464.8) and serum calcium concentration was 10.5 mg/dl (9, 11.5). We compared using 2D-SWE and strain elastography parathyroid adenoma with thyroid tissue and with surrounding muscle. e mean EI measured by SWE in parathyroid adenoma was 4.74 ± 2.74 kPa and in thyroid parenchyma was 11.718 ± 4.206 kPa (mean difference � 6.978 kPa, p < 0.001), and the mean EI value in muscle tissue was 16.362 ± 3.829 kPa (mean difference � 11.622, p < 0.001). Using ROC analysis, we found that an EI below 7 kPa correctly identifies parathyroid tissue. We evaluated parathyroid adenomas using strain elastography by color mapping and strain ratio as a semiquantitative measurement; however, we could not find any statistical correlation comparing the strain ratio obtained from the parathyroid adenoma with the thyroid tissue (p � 0.485). Conclusion. Ultrasound elastography is a helpful tool in identifying parathyroid adenomas. A cutoff value below 7 kPa can be used in 2D-SWE. Color maps in strain elastography without adding strain ratio can be used, parathyroid adenoma being identified as score 1 in the Rago criteria.

Thyroid Pathology in End-Stage Renal Disease Patients on Hemodialysis

“…We did not discuss in our study about the prevalence of secondary hyperparathyroidism, this topic and others on hyperparathyroidism was covered in previous articles [41,50]. However, we did not find any positive correlation between thyroid volume and serum PTH concentration.…”

Two-Dimensional Shear Wave Elastography of Normal Soft Tissue Organs in Adult Beagle Dogs; Interobserver Agreement and Sources of Variability

“…Two-dimensional shear wave elastography has been used mainly in diffuse liver disease for staging liver fibrosis in human medicine. Moreover, there are many studies about the 2D SWE application for differentiating between benign and malignant breast masses, differentiate between benign and malignant thyroid nodules, identification of the parathyroid adenoma and hyperplasia, and estimation of the kidney stiffness in chronic renal diseases ( Barr et al, 2015b ; Cosgrove et al, 2017 ; Golu et al, 2017 ; Lee et al, 2017 ; Bob et al, 2018 ; Kyriakidou et al, 2018 ; Liu et al, 2018 ; Cotoi et al, 2019 ; Grosu et al, 2019 ; Sãftoiu et al, 2019 ; Cotoi et al, 2020 ). In veterinary literature, 2D SWE was applied to distinguish malignant from benign conditions of mammary tumors and lymph nodes and to evaluate the margination and acute changes in stiffness of the ablated liver tissue after radiofrequency ablation in dogs ( Glińska-Suchocka et al, 2013 ; Feliciano et al, 2017 ; Lee et al, 2018 ; Silva et al, 2018 ).…”

Shear Wave Elastography in Patients with Primary and Secondary Hyperparathyroidism

“…Labeled as “palpation imaging”, elastography offers qualitative and quantitative information on the tissue anatomical architecture, identifying changes in tissue stiffness [ 20 , 22 , 23 , 24 ]. Elastography has been validated as a marker of pathological states in many clinical fields by facilitating the diagnosis, differential diagnosis, and therapeutic management and establishing its role in endocrinology (thyroid and parathyroid area) [ 25 , 26 ], hepatogastroenterology [ 20 , 27 , 28 , 29 ], senology [ 30 , 31 ], urology [ 32 , 33 , 34 ], and otorhinolaryngology [ 35 ].…”

“…Used in both primary and secondary hyperparathyroidism, elastography proved in our previous studies [ 25 , 37 ] to be an accurate predictor of parathyroid tissue when compared to thyroid or muscle tissue. For differential diagnosis in cases of coexistence of benign thyroid lesions, it still is an issue to be discussed in further studies.…”