Vitetta Giovanni Mariano, Neri Pierluigi, Chiecchio Andrea, Carriero Alessandro, Cirillo Stefano, Mussetto Annalisa Balbo, Codegone Alessandra
S.C. Radiodiagnostica A.O. Ordine Mauriziano di Torino, Ospedale Umberto I, Largo Turati, 62, 10128 Turin, Italy.
S.C.D.U. di Radiodiagnostica e Interventistica, Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara, Novara, Italy.
J Ultrasound. 2014 Jan 31;17(1):1-12. doi: 10.1007/s40477-014-0067-8. eCollection 2014 Mar.
Primary hyperparathyroidism (PHPT) is a common endocrine disorder that can be cured only by parathyroidectomy. Cervical ultrasonography and scintigraphy are the imaging studies most widely used for preoperative localization of the affected glands. The aim of this retrospective comparative study was to define the respective roles of ultrasonography and parathyroid scintigraphy in these cases.
We analyzed 108 patients who had undergone parathyroidectomies for PHPT following cervical ultrasonographic and scintigraphic examinations. The ultrasound examinations were carried out by an expert physician sonographer in 61 cases and by various physician sonographers with different levels of experience in 47 cases. Sonographic and scintigraphic findings were compared with surgical findings and the diagnostic performance of the two imaging methods was evaluated by means of statistical analysis.
The operator dependency of ultrasonography was confirmed by marked variations in sensitivity related to the experience of the sonographer. When sonography was performed by an expert, the sensitivity of combined use of the two methods was not significantly higher than that of sonography alone.
In expert hands, the diagnostic yield of ultrasound is appreciably superior. It can therefore be used as the main and possibly sole method for preoperative localization of pathological parathyroid tissues. Combined use of ultrasound and scintigraphy is not cost-effective in these cases. Scintigraphy is indicated only when the ultrasound examination produces negative results.
原发性甲状旁腺功能亢进症（PHPT）是一种常见的内分泌疾病，只能通过甲状旁腺切除术治愈。颈部超声检查和闪烁扫描是术前受影响腺体定位最广泛使用的影像学检查。这项回顾性比较研究的目的是确定超声检查和甲状旁腺闪烁扫描在这些病例中的各自作用。
我们分析了108例在接受颈部超声和闪烁扫描检查后因PHPT接受甲状旁腺切除术的患者。61例患者由超声专家医师进行超声检查，47例患者由经验水平不同的医师进行超声检查。将超声和闪烁扫描结果与手术结果进行比较，并通过统计分析评估两种成像方法的诊断性能。
超声检查的操作者依赖性通过与超声医师经验相关的敏感性显著差异得到证实。当由专家进行超声检查时，两种方法联合使用的敏感性并不显著高于单独使用超声检查的敏感性。
在专家手中，超声的诊断率明显更高。因此，它可以用作术前病理性甲状旁腺组织定位的主要甚至可能是唯一方法。在这些病例中，超声和闪烁扫描联合使用不具有成本效益。仅当超声检查结果为阴性时才需要进行闪烁扫描。
