Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

Slashchuk, Konstantin Y.; Degtyarev, M. V.; Rumyantsev, P O; Troshina, Ekaterina A.; Мельниченко, Г. А.

doi:10.14341/serg12241

Cited by 7 publications

(1 citation statement)

References 85 publications

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“…Персистенция ПГПТ по данным литературы чаще обусловлена ошибками в диагностике (нераспознанные патологические ОЩЖ), а рецидив -нерадикальным объемом удаленных ОЩЖ [19]. Наврот и соавт.…”

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Preoperative diagnosis of parathyroid gland pathology in patients with persistent or recurrent primary hyperparathyroidism: a retrospective study

Pospelov,

Novokshonov,

Chernikov

et al. 2024

Lučevaâ diagn. ter.

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INTRODUCTION: Localization of abnormal parathyroid glands in persistent or relapsed patients with primary hyperparathyroidism presents problems for surgeons before repeated surgery. There is no clear standard for the choice of diagnostic modality for localization of PG in this group of patients.OBJECTIVE: To search for the optimal diagnostic protocol of the parathyroid pathology preoperative diagnosis in patients with primary hyperparathyroidism with persistent or recurrent disease.MATERIALS AND METHODS: 55 patients diagnosed with persistence or recurrence of PHPT who underwent repeated surgical treatment were included in the study. Before surgical intervention all patients underwent laboratory and instrumental investigations in the volume of: blood tests for PTH, TTH, ionized calcium, 25(OH)D, creatinine, phosphorus, neck ultrasound, parathyroid scintigraphy by washout method, dual-isotope subtractive scintigraphy of parathyroid glands (early and delayed phases), SPECT of parathyroid glands (with uptake correction), computed tomography of the neck with intravenous bolus contrast.RESULTS: CT and planar subtraction dual-isotope scintigraphy showed the highest DA in the overall group (persistence and recurrence) (78% and 78%), with the DA of these methods differing slightly (88% and 92%) and overall accuracy being higher for CT (90% and 87%). Neck ultrasound showed the lowest rates among all methods (DA — 46%, DS — 80%, OA — 67%). Planar scintigraphy (washout) and SPECT were comparable in their informativeness: DA — 67% and 65%, DS — 96% and 98%, OA — 85% and 86%.DISCUSSION: The most commonly used current diagnostic search algorithm before reoperation is visualization of the thyroid gland by two modalities: Neck ultrasound and parathyroid scintigraphy (washout/subtraction) or SPECT-CT. In doubtful cases, the second step is computed tomography of the neck with contrast or PET/CT. It is extremely difficult to choose one optimal diagnostic method, as none of them has 100% diagnostic accuracy. In addition, each study has limitations, and the availability of some modalities is limited. In our study, the location of pathologically altered thyroid was correctly recognized in 90% of cases by CT with contrast and in 87% of cases by planar subtraction dual-isotope scintigraphy. The informativeness of neck ultrasound showed the lowest values of all modalities. SPECT and planar washout scintigraphy took an intermediate position in terms of diagnostic accuracy.CONCLUSION: Isolated ultrasonography of the neck has low diagnostic accuracy in patients with primary hyperparathyroidism with persistent or recurrent disease. We recommend the combination of US with contrast-enhanced computed tomography of the neck or US with dual isotope subtraction scintigraphy of the parathyroid glands, which have the same diagnostic accuracy. SPECT and planar washout scintigraphy can be used for the diagnosis of abnormal parathyroid glands in persistent or recurrent patients with primary hyperparathyroidism when more informative techniques are unavailable. When the techniques were combined, the combination of ultrasound/CT with contrast and ultrasound/planar subtraction dual isotope scintigraphy showed the best results with DA of 85% and 86%.

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Preoperative diagnosis of parathyroid gland pathology in patients with persistent or recurrent primary hyperparathyroidism: a retrospective study

Pospelov,

Novokshonov,

Chernikov

et al. 2024

Lučevaâ diagn. ter.

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Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum (case report)

Topolnitskiy,

Milovanova,

Apalkov

et al. 2024

Endo Serg

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Recently, primary hyperparathyroidism, which represents a medical and socially significant problem, has become increasingly relevant. The high prevalence of forms without pronounced clinical symptoms, as well as the low awareness of doctors regarding this pathology, lead to late diagnosis, delayed initiation of treatment and, as a consequence, the development of serious multisystem complications with a higher risk of premature death. At the same time, early diagnosis is based on relatively laboratory tests — serum calcium and parathyroid hormone, and visualization of the adenoma in most cases is provided by ultrasound examination and scintigraphy. This article is a case report of primary hyperparathyroidism caused by an ectopic parathyroid adenoma located in the mediastinum, when late treatment led to the patient’s long-term suffering and the development of severe complications.

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Preoperative imaging and intraoperative navigation of the parathyroid glands neoplasms in primary hyperparathyroidism

Slashchuk

Degtyarev

Rumiantsev³

et al. 2022

Opuholi golovy i šei

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Introduction. Primary hyperparathyroidism is one of the most common diseases of the endocrine system, after diabetes mellitus and thyroid pathologies. Early diagnosis and treatment of primary hyperparathyroidism allow avoiding severe damage to the bones, kidneys, other organs, thereby reducing the incidence of disability and improving the patients quality of life. The only radical treatment for primary hyperparathyroidism is the surgical removal of the pathologically altered, hyperfunctioning parathyroid glands.The study objective – to increase the efficiency of preoperative topical diagnosis and intraoperative navigation of parathyroid glands.Materials and methods. 200 patients with laboratory-verified primary hyperparathyroidism, who underwent preoperative topical diagnostics (ultrasound, planar scintigraphy and single-photon emission computed tomography, combined with computed tomography (SPECT / CT), in some cases supplemented with contrast enhanced CT with / or fine needle aspiration biopsy with flushing from a needle on for parathyroid hormone) and received surgical treatment, in period from 2017 to 2020. A single-stage, open-label comparative study was carried out, including clinical, laboratory and instrumental data of patients. The follow-up period after surgery for primary hyperparathyroidism was at least 6 months.Results. From 200 included patients, surgical treatment in the amount of minimally invasive parathyroidectomy was performed in 189 patients. As a result of the analysis of the diagnostic accuracy, for a combination of ultrasound and SPECT/CT with augmented contrast enhanced CT, the overall accuracy in visualizing of parathyroid glands was 99 % (95 % confidence interval (CI): 97–100), diagnostic specificity 77 % (95 % CI: 54–100), sensitivity 100 % (95 % CI: 98–100), the predictive value of positive and negative results was 98 % (95 % CI: 97–100) and 100 % (95 % CI: 98–100) respectively.Conclusion. The results allowed us to develop an algorithm for preoperative topical diagnosis of parathyroid glands in patients with laboratory-verified primary hyperparathyroidism and indications for surgical treatmen. We recommend to perform ultrasound of the thyroid and parathyroid glands in all patients at the first stage, in the absence of evident changes in the thyroid gland, at the second stage – scintigraphy and SPECT / CT with 99mTc-MIBI; in cases with significant concomitant functional or structural pathology of the thyroid gland – contrast enhanced CT; if necessary, supplementing fine needle aspiration biopsy with flushing from a needle on for parathyroid hormone.

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Imaging methods of the parathyroid glands in primary hyperparathyroidism. Literature review

Cited by 7 publications

References 85 publications

Preoperative diagnosis of parathyroid gland pathology in patients with persistent or recurrent primary hyperparathyroidism: a retrospective study

Preoperative diagnosis of parathyroid gland pathology in patients with persistent or recurrent primary hyperparathyroidism: a retrospective study

Primary hyperparathyroidism caused by an ectopic parathyroid adenoma in the mediastinum (case report)

Preoperative imaging and intraoperative navigation of the parathyroid glands neoplasms in primary hyperparathyroidism

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