Platz Batista da Silva Natascha, Jung Ernst Michael, Jung Friedrich, Schlitt Hans J, Hornung Matthias
Department of Radiology, University Hospital Regensburg, Germany.
Institute of Biomaterial Science and Berlin-Brandenburg Centre for Regenerative Therapies, Helmholtz-Zentrum Geesthacht, Teltow, Germany.
Clin Hemorheol Microcirc. 2018;70(4):423-431. doi: 10.3233/CH-189307.
Aim of this study was to firstly describe reproducible, objective perfusion parameters of contrast-enhanced ultrasound (CEUS) kinetics of parathyroid gland adenoma (PA) using perfusion analysis software (VueBox®, Bracco, Italy). Thereby the efficiency of quantitative CEUS for characterization of PA should be evaluated comparing US to postoperative histopathological findings after PA resection.
42 patients with symptoms/lab work suggestive of pHPT presented a parathyroid gland lesion in B-mode US, which was consequently analyzed by dynamic CEUS. CEUS was performed by one experienced examiner after i.v.-injection of max. 2.4 ml sulphurhexaflouride microbubbles saving digital DICOM cine loops (up to 25 s) and images. PA were evaluated during arterial, venous and late phase (up to 3 min.) for perfusion characterization. A retrospective, blinded VueBox® perfusion analysis of arterial phase of 28/42 PA was performed by a second, independent examiner placing 3 ROIs manually in the PA (center, rim of PA, surrounding thyroid gland tissue) to objectify findings. US findings were correlated to postoperative histology after PA resection.
Out of 42 patients with PA findings in CEUS, perfusion analysis could be performed in 28/42 cases only as some CEUS cine loops had too much moving. In three cases the second examiner could not detect PA retrospectively, in 25 cases PA were characterized correctly resulting in a sensitivity rate of 89.3 %. VueBox® perfusion analysis confirmed that PA present a persisting hypervascularization of the rim with higher TTP (mean 7.93 s centrally, 8.36 s rim-sided), mTT (mean 56.6 s centrally, 64.5 s rim-sided) and lower PE (mean 10542.93 rm2 centrally, 8909.21 rm2 rim-sided) peripherally followed by a central wash-out during later phases. RT was comparable in all defined regions.
VueBox® analysis of parathyroid gland CEUS examinations seemed to be a valuable tool for quantification of a PA's perfusion and can help to detect and localize hyperfunctional parathyroid glands prior to surgery.
本研究的目的是首先使用灌注分析软件（VueBox®，意大利百胜公司）描述甲状旁腺腺瘤（PA）的对比增强超声（CEUS）动力学中可重复的客观灌注参数。从而通过将超声检查结果与PA切除术后的组织病理学结果进行比较，评估定量CEUS对PA特征描述的有效性。
42例有症状/实验室检查提示原发性甲状旁腺功能亢进（pHPT）的患者在B超检查中发现甲状旁腺病变，随后进行动态CEUS分析。由一名经验丰富的检查人员在静脉注射最大2.4 ml六氟化硫微泡后进行CEUS检查，保存数字DICOM电影环（长达25秒）和图像。在动脉期、静脉期和晚期（长达3分钟）对PA进行灌注特征评估。由另一名独立检查人员对28/42例PA的动脉期进行回顾性、盲法VueBox®灌注分析，在PA中手动放置3个感兴趣区（PA中心、PA边缘、周围甲状腺组织）以客观化检查结果。将超声检查结果与PA切除术后的组织学结果进行关联。
在42例CEUS检查发现PA的患者中，仅28/42例能够进行灌注分析，因为一些CEUS电影环移动过多。3例中，第二名检查人员无法回顾性检测到PA，25例中PA被正确特征化，灵敏度为89.3%。VueBox®灌注分析证实，PA边缘持续存在血管过度增生，中心的平均达峰时间（TTP）为7.93秒，边缘为8.36秒，平均通过时间（mTT）中心为56.6秒，边缘为64.5秒，周边的灌注熵（PE）较低，中心为平均10542.93 rm2，边缘为89**09.21 rm2，后期中心出现廓清。所有定义区域的上升时间（RT）相当。
VueBox®对甲状旁腺CEUS检查的分析似乎是量化PA灌注的有价值工具，有助于在手术前检测和定位功能亢进的甲状旁腺。
