Contrast-enhanced approach to parathyroid lesions.

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Objectives. Despite the improvement in B-mode ultrasound (US) imaging quality, it may still be
challenging to distinguish between different parathyroid lesions. The objective was to evaluate the findings
of contrast-enhanced ultrasound (CEUS) in parathyroid lesions and to determine whether CEUS and CEUS
post-processing can help to differentiate between hyperplastic and neoplastic parathyroid glands.
Materials and Methods. In this prospective study, 88 patients (18–83 years, F:M = 74:14) with
hyperparathyroidism were recruited before parathyroid surgery. Multiparametric ultrasound – US, Colour
Doppler, Superb Microvascular Imaging (SMI), CEUS (SonoVue) images were acquired and quantitative
postprocessing was performed (VueBox). Results were compared with postsurgical morphology.
Results. The most common US characteristics of parathyroid adenoma (PA) vs hyperplasia (PH) were:
well defined, hypoechoic lesions with increased echogenicity in centre (67% and 52%, respectively), cystic
components (54% and 59%, respectively) with afferent vessel (93% for both), PA’s were larger on average
(p = 0.001). CEUS showed peripheral hypervascularity in early arterial phase (median = 10s), quickly
reaching peak contrast concentration (median = 15s), following early washout (median = 27s) in PA and
homogenous dynamics in PH with rapid washout (p = 0.001). The most prevalent morphological subtype of
adenoma was chief-cell adenoma (79%, n = 59). Number of adenomas (61% of oxyphil subtype) displayed
different pattern – preponderantly central enhancement. Fall time was shorter in PH’s compared to PA’s (8s
vs. 11s). CEUS sensitivity for parathyroid pathology prior to postprocessing vs after postprocessing – 90%
vs 98.2% and specificity 72.2% vs 85.3% (p = 0.1).
Conclusions. CEUS is valuable and powerful tool for the preoperative assessment of parathyroid
pathology with high sensitivity and specificity in differentiation of parathyroid lesions, including subtypes
of adenoma – majority of those are distinguished by peripheral uptake, central washout and slower
hemodynamics, compared to hyperplasia with homogeneous enhancement and rapid washout, whereas
oxyphilic adenomas showed predominantly central en hancement.
Original languageEnglish
Pages (from-to)541
JournalMedicina (Kaunas)
Issue numberSuppl.2
Publication statusPublished - 2023
EventInternational Scientific Conferences on Medicine & Public Health: Research Week 2023 Rīga Stradiņš University: Research Week 2023 Rīga Stradiņš University - Riga, Latvia
Duration: 27 Mar 202331 Mar 2023

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 3.4. Other publications in conference proceedings (including local)


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