Preoperative multiparametric ultrasound correlation with morphology in patients with primary hyperparathyroidism

Aim of prospective study since February 2019 was to evaluate sensitivity and specificity of multiparametric ultrasound and its morphological correlation in patients with primary hyperparathyroidism. Fifty-seven patients (18-77 age, 48(84%) females) with primary hyperparathyroidism prior to parathyroidectomy were enrolled in the study compared with postoperative morphology. Preoperatively, B-mode ultrasound, Colour-Doppler (CD), Superb Microvascular Imaging (SMI), Strain Elastography (SE), Strain Ratio (SR nodule/thyroid tissue), 2D Shear-Wave Elastography (SWE) in nodule and thyroid tissue and contrast-enhanced ultrasound (CEUS – SonoVue 2 ml + Sol. NaCl 0,9% 10 ml intravenous bolus) were performed with postprocessing of acquired data using VueBox application. Forty-eight (84%) patients presented with solitary adenomas, 5 (9%) single hyperplasia, 4 (7%) multiglandular disease – one double adenoma, one with 4 hyperplasias and adenoma, two patients - 1 hyperplasia and 1 adenoma. The morphologic subtypes of adenomas included chief cell, oxyphilic cell and clear water cell adenomas, with chief cell being the most common morphological subtype. Characteristic ultrasound features of parathyroid adenomas were hypoechoic, well defined lesions with increased central echogenicity (82%), peripheral-central vascularization (66%) with feeding vessel (100%), median size of adenoma 10 mm (2-29 mm). Hyperplasias were smaller lesions vs. adenomas (p=0,007). Adenomas presented as soft lesions on elastography (SE 1.8(0.5–2.3)), 2D-SWE 35kPa(11-46kPa). CEUS showed median hypervascularity in early arterial phase - 9s, peak contrast time median value - 15s, median early washout 29s in both - adenoma and hyperplasia. There was weak association between morphological subtypes of parathyroid lesions and washout time (Cramer’s V 0,33, p=0,125). Multiparametric ultrasound had sensitivity and specificity of 90% (95% CI 81.24–96.06) and 64% (CI 42.52–82.03), PPV 88% (CI 81.22–92.56), NPV 69% (CI 51.58–83.06), respectively. Multiparametric ultrasound showed high sensitivity for confirmation of parathyroid lesion but did not show difference between adenoma and hyperplasia.