Abstract

Background: Ultrasound detection of parathyroid hyperparathyroidism solely depends upon radiologist experience in all modalities. Large nodule more than 5 mm can be detected confidently in ultrasound alone with proper history. However nodule<2 mm, negative ultrasound, not traced nuclear medicine study, further patients have persistent primary hyperparathyroidism symptoms and biochemical parameters increased is challenging task. This small nodule establishing diagnosis with appropriate surgery treatment planning in symptomatic patients from minimal invasive surgery to total neck exploration alarms endocrine surgeons. Our study emphasis on value of advanced MR and CEUS imaging protocol in detecting even small nodules as compared to conventional CT and MR wherein sensitivity and specificity is low and moreover CT is radiation modality.
Objectives: This study directly compared diagnostic value of dynamic enhanced DEMR and 4D CT application for preoperative detection of solitary parathyroid nodule.
Patients and methods: 31 patients selected as sample volume. 18 positive patients detected incidental parathyroid nodule by USG with biochemical parameters were grouped for further evaluation. 3 patients showed negative ultrasound, but with increased lab value subjected to SPECT and lesion localized and grouped along with positive cases. 10 patients were initial suspected clinically but normal lab value and negative ultrasound set as control group in our study. Each patient provided written informed consent to participate in this study. All positive patients subjected to CEUS and 4D MR and within 2 weeks surgery planning done accordingly and specimen cytology results compared for positive cases as gold standard. Results: Surgery specimen revealed 16 solitary parathyroid adenomas, 3 parathyroid carcinoma, and 2 patients with atypical parathyroid lesion like cyst with no complication. These results are correlated with CEUS and 4D MR results. No evidence of multiple lesions/diffuse involvement noted in our study and these results are correlated with HPE. The diagnostic sensitivities for detection of parathyroid adenomas of 66% sensitivity and 94% specificity, PPV 66%, NPV 94% and accuracy 80% (n=21) by CEUS and DEMR.
Conclusion: This study demonstrates that CEUS/DEMR is more sensitive in preoperative localization of parathyroid adenomas versus parathyroid carcinoma and reduces morbidity by selective minimal invasive planning.

Keywords: Primary hyperparathyroidism; CEUS; DEMR; Histopathology; Parathyroid incidentaloma