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Parathyroid-gland ultrasonography in clinical and therapeutic evaluation of renal secondary hyperparathyroidism

Ecografia delle paratiroidi nella valutazione clinica e terapeutica dell’iperparatiroidismo secondario renale

  • Head and Neck Radiology / Radiologia del Capo e del Collo
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

This study evaluated the relationship between ultrasonographic (US) parameters of parathyroid glands (PTGs) in haemodialysis patients (HDP) and degree of secondary hyperparathyroidism (SHPT), therapeutic responsiveness and type of PTG hyperplasia (diffuse or nodular).

Materials and methods

In 85 HDP, we evaluated the following US parameters of all and of the largest PTGs: number, maximum longitudinal diameter (MLD), structural (hypoechoic, heterogeneous, nodular) and vascular (nonhypovascular, intermediate, hypervascular) echo-pattern scores. Sixty-nine HDP underwent medical therapy (vitamin D, 39; vitamin D/cinacalcet, 30) and 16 underwent parathyroidectomy. The 69 HDP were classified as responders [median intact parathyroid hormone (iPTH) ≤300 pg/ml during follow-up) or nonresponders (iPTH >300 pg/ml).

Results

Number, MLD and structural and vascular echo patterns of PTGs were significantly correlated with iPTH and calcium concentrations. In the 41 (59%) responders, number (0–1), MLD (<10 mm) and structural and vascular scores (1–2) of the largest PTG were significantly lower than in nonresponders. Receiver operating curve (ROC) curve analysis showed high sensitivity and specificity (90% and 73%, respectively) of the MLD (<10mm) of the largest PTG in the predicting therapeutic outcome. US and histological MLD are significantly correlated and predict the type of hyperplasia.

Conclusions

US parameters of PTGs are correlated to the degree of SHPT and type of hyperplasia and predict responsiveness to medical therapy.

Riassunto

Obiettivo

Scopo del presente lavoro è stato valutare le relazioni tra i parametri ecografici (US) paratiroidei (PTG) nei pazienti emodializzati (HDP) con la severità dell’iperparatiroidismo secondario (SHPT), la risposta alla terapia, il tipo d’iperplasia ghiandolare (diffusa o nodulare).

Materiali e metodi

In 85 HDP sono stati valutati i seguenti parametri US di tutte le PTG e di quella maggiore: diametro longitudinale massimo (MLD) gli ecopatterns strutturali (ipoecogeno, eterogeneo, nodulare] e vascolari (a-/ipo-vascolarizzato, intermedio, ipervascolarizzato). Sessantanove HDP sono stati sottoposti a terapia medica (39 con vitamina D; 30 con vitamina D/ cinacalcet) e 16 a paratiroidectomia. I 69 HDP sono stati classificati responders (R) [mediana ormone paratiroideo intatto (iPTH)≤300 pg/ml durante follow-up] o nonresponders (NR) (iPTH>300 pg/ml).

Risultati

Il numero di PTG, il MLD e gli eco-patterns strutturali e vascolari sono significamente correlati con calcemia e iPTH. In 41 (59%) R il numero (0–1), il MLD (<10 mm) e gli score strutturali e vascolari (1–2) della PTG maggiore erano significativamente inferiori rispetto ai NR. L’analisi della curva receiver operating curve (ROC) dimostra un’elevata sensibilità e specificità del MLD [90%/73%] della PTG maggiore (<10 mm) nel predire la risposta terapeutica. Il MLD ecografico ed istologico sono significativamente correlati e predicono il tipo di iperplasia.

Conclusioni

I parametri ecografici delle PTG sono correlati alla gravità del SHPT ed al tipo di iperplasia paratiroidea e predicono la risposta alla terapia medica.

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Authors and Affiliations

  1. Istituto Clinica Chirurgica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Roma, Italy

    C. Vulpio, M. Bossola, S. C. Magalini & P. Silvestri

  2. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Roma, Italy

    M. Ciliberti, M. L. D’Andrea & G. Maresca

  3. Istituto di Anatomia Patologica, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Roma, Italy

    G. Fadda

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  1. C. Vulpio
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Correspondence to C. Vulpio.

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Vulpio, C., Bossola, M., Magalini, S.C. et al. Parathyroid-gland ultrasonography in clinical and therapeutic evaluation of renal secondary hyperparathyroidism. Radiol med 118, 707–722 (2013). https://doi.org/10.1007/s11547-012-0882-x

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