Department of Radiology, Division of Abdominal Imaging, University of Pittsburgh School of Medicine, 200 Lothrop St., Presbyterian South Tower, Ste. 3950, Pittsburgh, PA 15213, USA.
AJR Am J Roentgenol. 2010 Dec;195(6):1385-90. doi: 10.2214/AJR.10.4472.
The purpose of this study was to describe the typical ultrasound features of cystic parathyroid adenoma.
A review of a surgical database and electronic medical records from 2006 to 2009 identified the cases of 15 patients who underwent preoperative cervical sonography for primary hyperparathyroidism with subsequent resection of pathologically proven parathyroid adenoma with predominantly cystic components. Two radiologists retrospectively evaluated the preoperative ultrasound images and assessed for cyst complexity, size, location, and color Doppler vascularity. Technetium-99m-sestamibi SPECT findings, surgical and pathologic reports, and the results of parathyroid hormone assay of the cyst fluid also were reviewed.
Most of the cystic adenomas (14/15, 93%) were deep or inferolateral to the adjacent thyroid. The same percentage were elongated and had peripheral nodular components. An echogenic border separating the adenoma from the overlying thyroid was identified in 9 of 15 patients (60%). Color Doppler examination of 14 patients showed feeding vessels with internal color flow to the solid components in 10 patients (71%). Six of 14 patients underwent preoperative or intraoperative sampling of cyst fluid, and the assay showed the parathyroid hormone levels ranged from 1,198 to greater than 5,000 pg/mL. Fourteen of 15 patients underwent preoperative sestamibi SPECT, and the adenoma was definitively localized in four patients (29%). The accuracy of preoperative localization improved to 79% (11/14) when sestamibi SPECT scans were interpreted in correlation with cervical ultrasound images.
Awareness of typical sonographic features (location, color Doppler vascularity) may aid radiologists in preoperative localization of parathyroid adenomas, even when cystic degeneration occurs. In cases in which imaging or clinical features are equivocal, the results of cyst fluid sampling and parathyroid hormone assay are confirmatory.
本研究旨在描述甲状旁腺囊肿腺瘤的典型超声特征。
回顾 2006 年至 2009 年的手术数据库和电子病历，确定了 15 例因原发性甲状旁腺功能亢进症行术前颈部超声检查并随后切除病理证实的以囊性成分为主的甲状旁腺腺瘤的患者。两名放射科医生回顾性评估术前超声图像，并评估囊肿的复杂性、大小、位置和彩色多普勒血流情况。还回顾了锝-99m-甲氧基异丁基异腈 SPECT 发现、手术和病理报告以及囊肿液甲状旁腺激素检测结果。
大多数囊性腺瘤（14/15，93%）位于甲状腺的深层或下外侧。同样的比例是拉长的，并具有周边结节成分。在 15 例患者中有 9 例（60%）识别出将腺瘤与上方甲状腺分隔开的回声边界。对 14 例患者进行彩色多普勒检查，在 10 例（71%）患者中发现有向实性成分供应的血流。6 例患者在术前或术中对囊肿液进行采样，检测结果显示甲状旁腺激素水平在 1198 至大于 5000 pg/ml 之间。15 例患者中有 14 例行术前锝-99m-甲氧基异丁基异腈 SPECT 检查，4 例（29%）患者确定了腺瘤的位置。当将 SPECT 扫描与颈部超声图像结合解释时，术前定位的准确性提高到 79%（11/14）。
即使发生囊性变性，了解典型的超声特征（位置、彩色多普勒血流）也可以帮助放射科医生对甲状旁腺腺瘤进行术前定位。在影像学或临床特征不确定的情况下，囊肿液采样和甲状旁腺激素检测结果具有确认性。
