Highly efficient localization of pathological glands in primary hyperparathyroidism using contrast-enhanced ultrasonography (CEUS) in comparison with conventional ultrasonography.

INTRODUCTION: Preoperative detection of parathyroid gland adenoma in the presence of primary hyperparathyroidism (pHPT) represents a diagnostic challenge. We present the first prospective study with contrast-enhanced ultrasonography (CEUS) as the central diagnostic tool for the preoperative localization of parathyroid gland adenoma in pHPT in comparison with conventional ultrasonography.

METHODS: Between July 2010 and December 2011, 75 consecutive patients underwent surgery for pHPT. In all patients, conventional ultrasonography and CEUS were performed prospectively for localization of pathological parathyroid glands. Twenty-five patients suffered from a concomitant goiter (CG), and 12 patients had undergone previous neck surgery due to thyroid pathologies. The sensitivity of both diagnostic tools was analyzed in comparison with intraoperative and histological findings.

RESULTS: CEUS had a sensitivity of 97% for the detection of the correct quadrant of the pathological parathyroid gland and of 99% for the correct side in comparison with 70% for conventional ultrasonography. In multivariate regression analysis, CG, gland size, and body mass index had a relevant impact on incorrect findings by conventional ultrasonography as compared with CEUS. Follow-up with a minimum of 6 months after surgery showed normal serum levels of calcium and PTH in all 75 patients.

CONCLUSIONS: CEUS represents a highly reliable, noninvasive and nonradioactive diagnostic tool for localization of pathological parathyroid glands in patients with pHPT. Even in the presence of CG, previous neck surgery, or double adenomas, CEUS has a high sensitivity.