Cotoi Laura, Amzar Daniela, Sporea Ioan, Borlea Andreea, Navolan Dan, Varcus Flore, Stoian Dana
PhD School Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Department of Endocrinology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Int J Endocrinol. 2020 Mar 17;2020:3801902. doi: 10.1155/2020/3801902. eCollection 2020.
The aim of the study was to compare elastographic means in parathyroid adenomas, using shear wave elastography and strain elastography.
This prospective study examined 20 consecutive patients diagnosed with primary hyperparathyroidism and parathyroid adenoma, confirmed by biochemical assay, technetium-99 sestamibi scintigraphy, and pathology report, after parathyroid surgery. All patients were examined on conventional 2B ultrasound, 2D shear wave elastography, and strain elastography. We determined using 2D shear wave elastography (SWE) the elasticity index (EI) in parathyroid adenoma, thyroid parenchyma, and surrounding muscle and examined using strain elastography the parathyroid adenoma, and determined the strain ratio with the thyroid tissue and muscle tissue.
All patients had positive sestamibi scintigraphy and underwent surgery, with confirmation of parathyroid adenoma in all cases. The mean parathormone (PTH) value before surgery was 153.29 pg/ml (36.5, 464.8) and serum calcium concentration was 10.5 mg/dl (9, 11.5). We compared using 2D-SWE and strain elastography parathyroid adenoma with thyroid tissue and with surrounding muscle. The mean EI measured by SWE in parathyroid adenoma was 4.74 ± 2.74 kPa and in thyroid parenchyma was 11.718 ± 4.206 kPa (mean difference = 6.978 kPa, < 0.001), and the mean EI value in muscle tissue was 16.362 ± 3.829 kPa (mean difference = 11.622, < 0.001). Using ROC analysis, we found that an EI below 7 kPa correctly identifies parathyroid tissue. We evaluated parathyroid adenomas using strain elastography by color mapping and strain ratio as a semiquantitative measurement; however, we could not find any statistical correlation comparing the strain ratio obtained from the parathyroid adenoma with the thyroid tissue (=0.485).
Ultrasound elastography is a helpful tool in identifying parathyroid adenomas. A cutoff value below 7 kPa can be used in 2D-SWE. Color maps in strain elastography without adding strain ratio can be used, parathyroid adenoma being identified as score 1 in the Rago criteria.
本研究旨在使用剪切波弹性成像和应变弹性成像比较甲状旁腺腺瘤的弹性成像均值。
这项前瞻性研究检查了20例连续诊断为原发性甲状旁腺功能亢进和甲状旁腺腺瘤的患者，这些患者在甲状旁腺手术后经生化检测、锝-99甲氧基异丁基异腈闪烁扫描和病理报告确诊。所有患者均接受常规2B超声、二维剪切波弹性成像和应变弹性成像检查。我们使用二维剪切波弹性成像（SWE）测定甲状旁腺腺瘤、甲状腺实质和周围肌肉的弹性指数（EI），并使用应变弹性成像检查甲状旁腺腺瘤，测定其与甲状腺组织和肌肉组织的应变比。
所有患者的甲氧基异丁基异腈闪烁扫描均为阳性并接受了手术，所有病例均确诊为甲状旁腺腺瘤。术前甲状旁腺激素（PTH）的平均水平为153.29 pg/ml（36.5，464.8），血清钙浓度为10.5 mg/dl（9，11.5）。我们使用二维SWE和应变弹性成像将甲状旁腺腺瘤与甲状腺组织及周围肌肉进行比较。SWE测得甲状旁腺腺瘤的平均EI为4.74±2.74 kPa，甲状腺实质的平均EI为11.718±4.206 kPa（平均差值=6.978 kPa，<0.001），肌肉组织的平均EI值为16.362±3.829 kPa（平均差值=11.622，<0.001）。使用ROC分析，我们发现EI低于7 kPa可正确识别甲状旁腺组织。我们通过彩色映射和应变比作为半定量测量，使用应变弹性成像评估甲状旁腺腺瘤；然而，我们未发现甲状旁腺腺瘤与甲状腺组织的应变比之间存在任何统计学相关性（=0.485）。
超声弹性成像是识别甲状旁腺腺瘤的有用工具。二维SWE可使用低于7 kPa的临界值。可不添加应变比使用应变弹性成像中的彩色图，根据拉戈标准，甲状旁腺腺瘤被识别为1分。
