Usefulness of echo-color Doppler in differentiating parathyroid lesions from other cervical masses

Mazzeo, Salvatore; Caramella, Davide; Lencioni, Riccardo; Viacava, Paolo; Liperi, Annalisa De; Naccarato, Antonio Giuseppe; Armillotta, Nicola; Marcocci, Claudio; Miccoli, Paolo; Bartolozzi, Carlo

doi:10.1007/s003300050116

Cited by 39 publications

(29 citation statements)

References 17 publications

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“…Color Doppler sonography is useful in differentiating parathy mid adenomasfrom other cervical masses [13,14]; however,to our knowledge, an increased detection rate of color Doppler sonography over conventional gray-scale imaging has not beenreported [15].…”

Section: Conclusion Prominent Vessels Supplying Parathyroid Adenomasmentioning

confidence: 87%

Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas.

Lane¹,

Desser²,

Weigel³

et al. 1998

American Journal of Roentgenology

121

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OBJECTIVE. The objectiveof our studywas to determinethe value of usingcolor and power Doppler sonography to reveal extrathyroidal feeding arteries in the detection of abnor mal parathyroid glands. SUBJECTSAND METHODS.Forty-four patients withprimaiy hyperparathyroidism wereimaged prospectively with high-resolution gray-scale,color flow, and power Doppler sonogra phy. The presence of extrathyroidal arteries supplying the adenomas was noted. All patients un derwent subsequent neck exploration. The locations of the abnormal glands were recorded. RESULTS. At surgery, 51abnormal parathyroid glands wereremoved inthe44patients.Sonography correctly revealed an adenomain 40 of the 44 patients. Likewise, sonography re vealed 42 of the 51 adenomas. Nine false-negative and two false-positive interpretations of the sonograms were made. Thus, overall sensitivity was 83%, specificity was 98%, and accu racy was 94%. Three of the false-negative interpretations were ectopic glands within the supe nor mediastinum. Excluding thesethree glands from analysis, the sensitivity for detection of adenomas within the neck was 88%, specificity was 98%, and accuracy was 95%. An ex trathyroidal artery leading to a parathyroid adenoma was seen in 35 of the 42 adenomas re vealed by sonography. The presenceof an extrathyroidal artery leading to an adenoma was found to aid in the detection of an otherwise inconspicuous parathyroid gland in five patients, which improved sensitivity from 73% to 83%. CONCLUSION. Prominent vessels supplying parathyroid adenomas arefrequently revealed by color flow and power Doppler sonography.These vesselscan serve as â€oe¿ road mapsâ€• to abnormal parathyroid glands.

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Section: Conclusion Prominent Vessels Supplying Parathyroid Adenomasmentioning

confidence: 87%

Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas.

Lane¹,

Desser²,

Weigel³

et al. 1998

American Journal of Roentgenology

121

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“…However, the coexistence of a thyroid disease, particularly nodular goiter, may cause false-positive observations (11,12,14). Over the past few years, major efforts have been put into developing new techniques to increase the sensitivity and accuracy of preoperative localization studies.…”

Section: Discussionmentioning

confidence: 99%

“…The use of 99m Tc-MIBI has markedly improved scintigrapic results (4), but a few patients with surgically proved primary hyperparathyroidism still have false-negative results, particularly in the presence of thyroid diseases (12). In the field of US, increased accuracy has been obtained by integrating the gray-scale results with color Doppler study (14).…”

Section: Discussionmentioning

confidence: 99%

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Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates

Marcocci

Mazzeo

Bruno-Bossio³

et al. 1998

European Journal of Endocrinology

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Objective: To determine the usefulness of parathyroid hormone (PTH) measurement in needle aspirates of a suspicious neck mass to confirm its parathyroid nature in patients with primary hyperparathyroidism. Methods: Thirty-three patients with surgically proved primary hyperparathyroidism were submitted to neck ultrasound (US), parathyroid scintigraphy, and assay of PTH in the aspirate (PTHa) of the suspicious cervical mass. Results: Based on the results of neck US and parathyroid scintigraphy, patients were divided into two groups. Group 1: 16 patients (seven with nodular goiter) with concordant positive US and scintigraphic results. In all but one patient, PTHa was detectable and often markedly elevated (>1000 pg in 12 patients, between 292 pg and 803 pg in three patients and 53 pg in one patient). The patient with undetectable PTHa had a small lower left parathyroid adenoma (8×8×10 mm). Group 2: 17 patients (12 with nodular goiter) with discordant US and scintigraphic results. PTHa established the parathyroid nature of the mass in 13 cases (>1000 pg in 8 patients, between 501 pg and 953 pg in three patients and 90 and 79 pg in two patients): 11 of these had a suspected lesion by US examination but the scintigraphy results were negative; two had a mass that gave positive scintigraphy results but was of uncertain origin according to US; in both cases an intrathyroidal parathyroid adenoma was found. PTHa was undetectable in four cases (three with nodular goiter): all of these had equivocal US results, and three had positive scans and one a negative scan. Conclusions: Assay of PTHa is a simple method and should be useful for confirming the parathyroid nature of a cervical mass in patients with discordant or non-diagnostic US and scintigraphic results.

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“…The diagnostic role of ultrasonography (US) of parathyroid glands (PTG) in uremic secondary hyperparathyroidism (SHPT) is still controversial [1,2,3,4,5,6,7,8,9,10]. The US sensitivity and specificity in primary parathyroid adenoma (80–95%) are higher than those of secondary hyperplasia involving all PTG (60–75%).…”

Section: Introductionmentioning

confidence: 99%

Ultrasound Patterns of Parathyroid Glands in Chronic Hemodialysis Patients with Secondary Hyperparathyroidism

Vulpio

Bossola

Gaetano³

et al. 2008

Am J Nephrol

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Background: The role ofparathyroid glands (PTG) ultrasonography (US) in hemodialysis patients with secondary hyperparathyroidism (SHPT) is still controversial. The present study aimed at evaluating the relationship between US findings and SHPT degree as well as therapeutic outcome. Methods: Twenty hemodialysis patients with moderate SHPT and 15 with severe SHPT underwent US to assess the PTG number, maximum longitudinal diameter (MLD), structural (1 – hypoechoic, 2 – slight heterogeneous, 3 – high heterogeneous, 4 – nodular) and vascular patterns (1 – slight, 2 – medium and 3 – high). Results: PTG number, MLD and US patterns were correlated with iPTH levels. MLD of patients with moderate or severe SHPT was 7.2 ± 2.3 and 15 ± 5.1 mm (p < 0.001). Most patients with moderate SHPT showed a single PTG with an MLD <9 mm associated with 1–2 structural and vascular pattern, whereas patients with severe SHPT exhibited more than one PTG with MLD >9 mm and 3–4 structural and vascular patterns. Thirteen patients were responders to treatment and 22 nonresponders. In nonresponders, a higher number of PTG was observed as well as higher echostructural and vascular patterns. In 14 patients who underwent parathyroidectomy, no differences were found between PTG US MLD and pathology diameter. All PTG with evidence of 3–4 structural and vascular score at ultrasound showed nodular hyperplasia at pathological examination. Conclusions: The adopted classification of US findings is correlated with SHPT degree and therapeutic outcome and might be an adjunctive predictive method useful to assess the SHPT severity and to plan the therapeutic strategy.

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Usefulness of echo-color Doppler in differentiating parathyroid lesions from other cervical masses

Cited by 39 publications

References 17 publications

Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas.

Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas.

Preoperative localization of suspicious parathyroid adenomas by assay of parathyroid hormone in needle aspirates

Ultrasound Patterns of Parathyroid Glands in Chronic Hemodialysis Patients with Secondary Hyperparathyroidism

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