高分辨率超声联合彩色多普勒超声用于原发性甲状旁腺功能亢进患者甲状旁腺腺瘤的术前定位

High-resolution ultrasound in combination with colour-Doppler sonography for preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism.

作者信息

Rickes S, Sitzy J, Neye H, Ocran K W, Wermke W

机构信息

Dept. of Gastroenterology, Hepatology and Endocrinology, University Hospital Charité, Campus Mitte, Berlin, Germany.

出版信息

Ultraschall Med. 2003 Apr;24(2):85-9. doi: 10.1055/s-2003-38667.

DOI:10.1055/s-2003-38667

PMID:12698372

Abstract

BACKGROUND AND AIMS

Experienced surgeons have the highest sensitivity in the localization of parathyroid adenomas in patients with primary hyperparathyroidism. Correct preoperative localization, however, allows unilateral neck exploration with subsequently reduced operative time and complication rate. In this prospective study, we investigated the accuracy of preoperative high-resolution ultrasound in combination with colour-Doppler sonography for the detection of parathyroid lesions.

SUBJECTS/METHODS: Ninety-eight patients (mean age 59.1 years, range 15-86) who referred to our department with symptomatic primary hyperparathyroidism were included in the study from January 1998 to June 2002. Sonography was performed by experienced examiners. The exact diagnosis was based on surgical findings and histology in all patients.

RESULTS

The overall sensitivity for the sonographical localization of the adenomas on the correct side of the neck was 86 %. Twenty-three percent of the adenomas located on the cranial margin of the thyroid gland were diagnosed correctly, as were 92 % of the lesions located caudally (p = 0.0001). The detection of feeding vessels was possible by colour-Doppler sonography in 60 % of the cases. The diagnosis was correct for 93 % of these suspected adenomas. No vessels were detected in the remaining lesions, and only 39 % of these tumours were diagnosed correctly (p = 0.0001).

CONCLUSIONS

High-resolution ultrasonography by experienced examiners is a highly sensitive procedure for the preoperative diagnosis of parathyroid adenomas in patients with primary hyperparathyroidism. With this method, a unilateral neck exploration is sufficient in about 90 % of the patients. Additionally, detection of feeding vessels by colour-Doppler sonography is an important indication of a parathyroid lesion. Nonetheless, the experienced surgeon remains the standard of reference.

摘要

背景与目的

在原发性甲状旁腺功能亢进患者中，经验丰富的外科医生对甲状旁腺腺瘤的定位具有最高的敏感性。然而，正确的术前定位可使颈部单侧探查得以进行，从而缩短手术时间并降低并发症发生率。在这项前瞻性研究中，我们调查了术前高分辨率超声联合彩色多普勒超声检测甲状旁腺病变的准确性。

对象/方法：1998年1月至2002年6月期间，98例因症状性原发性甲状旁腺功能亢进转诊至我科的患者被纳入研究。超声检查由经验丰富的检查人员进行。所有患者的明确诊断均基于手术结果和组织学检查。

结果

腺瘤在颈部正确一侧的超声定位总体敏感性为86%。位于甲状腺颅侧边缘的腺瘤中，23%被正确诊断，而位于尾侧的病变中，92%被正确诊断（p = 0.0001）。彩色多普勒超声在60%的病例中能够检测到供血血管。这些疑似腺瘤中93%的诊断是正确的。其余病变未检测到血管，这些肿瘤中只有39%被正确诊断（p = 0.0001）。