The Dark Side of Ultrasound Imaging in Parathyroid Disease

Abstract

The diagnosis of parathyroid diseases by imaging still has some intrinsic technical limitations due to the differential diagnosis of different structures of the neck that mimic the parathyroid glands. In this view, ultrasound (US) is an established, low-cost, and non-invasive imaging technique that still represents the first-line approach for evaluating patients with parathyroid disease. The objective of this article is to provide a comprehensive review of the applications of USs in clinical practice, discussing the histopathological and US characteristics of the parathyroid glands in normal and pathological conditions, the advantages of preoperative imaging, and novel updates on the most useful and currently available multiparameter US techniques.

Differentiating pathologic parathyroid glands from thyroid nodules on neck ultrasound: the PARATH-US cross-sectional study

“…Importantly, we did not perform contrast-enhanced US, a technique that has proven highly useful to diagnose and locate PPGs, especially to explore the vascular architecture. 42 , 43 Furthermore, given the nature of our samples, we were not able to perform specific PTH or GATA-3 staining or PTH mRNA quantification on cytopathology, which are useful complementary techniques to help distinguishing thyroid from parathyroid tissues. 44 …”

Differentiating thyroid nodules parathyroid lesions using 2D-shear-wave elastography: a novel approach for enhanced diagnostic accuracy

“…Conventional US characteristics and Color Doppler US are not able to differentiate alone between adenoma and hyperplasia. In B-mode, pathological parathyroids may appear as oval-shaped lesions that are enlarged, confined, hypoechoic, and bordered by hyperechoic connective tissue ( 6 ). Both adenoma and hyperplasia are typically shown on the Color Doppler with significant feeding polar arteries which enter the pole and extend along the edge of the parathyroid gland ( 30 ).…”

“…There are also cases that associate both thyroid nodules and parathyroid adenomas or hyperplasia, making the diagnosis even more difficult ( 5 ). US-based methods, such as Color Doppler, different elastography methods and contrast-enhanced ultrasound (CEUS) are thought to aid the diagnosis and multiple studies focused their attention on developing a US-based multiparametric model ( 6 ). Nonetheless, current guidelines have yet to endorse multimodal evaluation, due to the lack of cost-effectiveness data and insufficient evidence supporting this approach.…”