Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India, 632004,
Insights Imaging. 2014 Feb;5(1):103-11. doi: 10.1007/s13244-013-0297-x. Epub 2013 Nov 29.
To describe atypical ultrasound features of parathyroid lesions and correlate them with clinical presentation and histopathology.
Retrospective review of 264 patients with primary hyperparathyroidism who underwent ultrasound imaging prior to parathyroidectomy was performed. Patients with atypical ultrasound findings (n = 26) were identified; imaging findings were correlated with clinical presentation and histopathology.
Twenty-one (80 %) lesions were adenomas, two (8 %) were adenomas with cellular atypia, and three (11.5 %) were carcinomas. Seventeen (65 %) lesions showed cystic change; five (19 %) of them had >50 % cystic change. These lesions were adenomas with cystic degeneration. Cystic degeneration had significant positive correlation with the lesion size and PTH level, but cystic adenomas correlated negatively with lesion weight. Six (23 %) lesions were isoechoic and one (4 %) was hyperechoic; histology predominantly revealed haemorrhage, hyalinisation and fibrosis; one lesion showed fat deposition and another had multiple granulomas within the adenoma. Twenty (83 %) lesions had heterogeneous echotexture and showed combinations of acinar dilatation, necrosis, haemorrhage and fibrosis. Heterogeneous lesions tended to be significantly larger and heavier, and they were associated with higher PTH levels. Four (15 %) lesions had calcifications. Scintigraphy was concordant in 22 (96 %), n = 23. One scintigraphy-negative lesion was a cystic parathyroid adenoma.
Atypical ultrasound features of parathyroid lesions pose a diagnostic challenge. Awareness of these features would help improve lesion detection.
描述甲状旁腺病变的不典型超声特征，并将其与临床表现和组织病理学相关联。
对 264 例原发性甲状旁腺功能亢进症患者在甲状旁腺切除术前行超声成像的回顾性研究。确定了具有不典型超声发现的患者（n=26）；将影像学发现与临床表现和组织病理学相关联。
21 例（80%）病变为腺瘤，2 例（8%）为有细胞异型性的腺瘤，3 例（11.5%）为癌。17 例（65%）病变表现为囊性改变；其中 5 例（19%）囊性改变>50%。这些病变为囊性退变的腺瘤。囊性退变与病变大小和 PTH 水平呈显著正相关，但囊性腺瘤与病变重量呈负相关。6 例（23%）病变为等回声，1 例（4%）为高回声；组织学主要表现为出血、玻璃样变和纤维化；1 例病变显示脂肪沉积，另 1 例腺瘤内有多个肉芽肿。20 例（83%）病变回声不均匀，表现为腺泡扩张、坏死、出血和纤维化的组合。不均匀病变往往显著更大和更重，并且与更高的 PTH 水平相关。4 例（15%）病变有钙化。22 例（96%）患者的闪烁扫描结果一致，n=23。1 例闪烁扫描阴性的病变为囊性甲状旁腺腺瘤。
甲状旁腺病变的不典型超声特征构成诊断挑战。对这些特征的认识将有助于提高病变的检出率。
