The Diagnostic Value of Contrast‐Enhanced Ultrasound for Localization of Parathyroid Lesions in Primary Hyperparathyroidism

Piccin, Ottavio; D'Alessio, Pasquale; Serra, Carla; Felicani, Cristina; Vicennati, Valentina; Repaci, Andrea; Pagotto, Uberto; Cavicchi, Ottavio

doi:10.1002/jum.15984

Cited by 1 publication

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References 23 publications

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“…In our experience, however, CEUS was only feasible in lesions that had already been visualized on US. This observation is in contrast to some of the earliest studies on US vs CEUS, but in line with a recent study showing no significant difference in sensitivity between color Doppler US and CEUS . An explaining factor for these conflicting results could be technical improvements in US with regard to image resolution, combined with the availability of advanced Doppler flow modes that now enable the visualization of small vessels without the need for an exogenous contrast agent .…”

Section: Discussionsupporting

confidence: 63%

Evaluation of Surgeon-Performed Ultrasonography With or Without Contrast Enhancement vs Scintigraphy in Patients With Primary Hyperparathyroidism

Michaelsen

Bay

Gerke

et al. 2023

JAMA Otolaryngol Head Neck Surg

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ImportanceScintigraphy and ultrasonography are common imaging modalities for the preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism. When comparing the 2 modalities, the benefits of ultrasonography in terms of convenience, patient comfort, duration, cost, and lack of radiation should be taken into account.ObjectiveTo investigate whether surgeon-performed ultrasonography, with or without contrast-enhanced ultrasonography (CEUS), is noninferior to scintigraphy for localizing pathological parathyroid glands in patients with primary hyperparathyroidism.Design, Setting, and ParticipantsProspective, paired, noninferiority cohort study performed at a high-volume tertiary referral center for parathyroidectomy with blinded examiners and a 6-month follow-up. Participants were adults (age ≥18 years) referred for parathyroidectomy due to primary hyperparathyroidism. Of 207 eligible patients, 35 were excluded, leaving 172 enrolled in the study. Inclusion lasted from September 2019 until February 2021. Follow-up ended in December 2021.Exposures99mTechnetium-pertechnetate/99mtechnetium-sestamibi subtraction scintigraphy with 99mtechnetium-sestamibi single-photon emission computed tomography/computed tomography, followed by surgeon-performed ultrasonography and CEUS.Main Outcomes and MeasuresThe sensitivity of each imaging modality in localizing pathological parathyroid glands, calculated on a per-quadrant and a per-patient basis, respectively. The a priori noninferiority margin was a lower 95% confidence limit for the difference in sensitivity not falling below −10%.ResultsOut of 172 participants, 139 (80.8%) were women, the median (range) age was 65 (24-87) years, and the median (IQR) follow-up was 200.5 (181-280.25) days. Quadrant sensitivity (95% CI) was 70.9% (63.2%-78.5%) for ultrasonography, 68.4% (60.4%-76.5%) for ultrasonography plus CEUS, and 67.0% (60.0%-74.0%) for scintigraphy. The sensitivity difference (95% CI) compared with scintigraphy was 3.9% (−4.1% to 11.8%) for ultrasonography and 1.5% (−6.4% to 9.3%) for ultrasonography plus CEUS, establishing noninferiority for both modalities. Per-patient sensitivity was 81.4% (74.8%-86.9%) for ultrasonography and 79.1% (72.2%-84.9%) for both scintigraphy and ultrasonography plus CEUS. The sensitivity difference compared with scintigraphy was 2.3% (−6.8% to 11.4%) for ultrasonography and 0.0% (−9.1% to 9.1%) for ultrasonography plus CEUS, establishing noninferiority for both modalities.Conclusions and RelevanceIn this cohort study, conventional ultrasonography by an experienced parathyroid surgeon-sonographer was noninferior to scintigraphy and may constitute a valid first-line imaging modality in patients with primary hyperparathyroidism, even without the addition of CEUS. Further imaging should be reserved for cases that are equivocal or nonlocalizing on ultrasonography.

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Section: Discussionsupporting

confidence: 63%