Liu Yang, Wu Songsong, Peng Chengzhong, Chai Huihui, Yu Mingan, Qian Linxue, Shan Yue, Zhang Luxin, Yu Jie, Liu Fangyi, Liang Ping
Department of Interventional Ultrasound, The Fifth Medical Center, Chinese PLA General Hospital, Haidian District, China.
Fujian Provincial Hospital, Department of Ultrasonography, Fuzhou, China.
Eur Radiol. 2025 Aug 6. doi: 10.1007/s00330-025-11862-0.
To evaluate the long-term efficacy and safety of Ultrasound (US)-guided percutaneous thermal ablation for recurrent or persistent secondary hyperparathyroidism (SHPT) and identify predictors of treatment failure.
From January 2014 to July 2023, 102 patients with recurrent or persistent SHPT after parathyroidectomy or ablation received thermal ablation. The median follow-up period was 30 months. The primary endpoint was the proportion of participants who achieved target parathyroid hormone (PTH) levels (≤ 300 pg/mL) at the end of follow-up. The secondary endpoints were the mean changes in levels of PTH, calcium, phosphorus, and alkaline phosphatase (ALP) from baseline; the technical success rate; and complications. Univariate and multivariate logistic regression analyses were performed to identify independent prognostic factors affecting the prognosis of ablation.
A total of 102 participants (mean age, 52 ± 12 years) with 174 hyperplastic parathyroid glands were evaluated. Overall, 87.3% of the participants achieved the target PTH level. Compared to baseline, significant reduction was achieved in PTH, calcium, phosphorus, and ALP levels (p < 0.05). The technical success rate was 100%. For major complications, one (1.0%) participant experienced persistent laryngeal nerve paralysis after ablation, and severe hypocalcemia occurred in 29 participants but did not result in serious comorbidities following calcium supplementation. The only independent predictor of treatment failure was baseline PTH ≥ 1606 pg/mL (odds ratio, 5.1; 95% CI: 1.1-23.1; p = 0.04).
US-guided thermal ablation is safe and effective for recurrent or persistent SHPT. Baseline PTH ≥ 1606 pg/mL is a key predictor of treatment failure.
Question Recurrent/persistent SHPT lacks safe, minimally invasive therapies, while traditional repeat surgery poses high complication risks due to fibrosis and anatomical distortion. Findings The study demonstrated 87.3% in achieving target PTH levels. The incidence of severe hypocalcemia reached 28.4%. Clinical relevance This pioneering multicenter study with a large sample size demonstrates the long-term effectiveness and safety of US-guided percutaneous thermal ablation for treating recurrent and persistent SHPT. It offers a viable nonsurgical alternative for managing this condition.
评估超声（US）引导下经皮热消融治疗复发性或持续性继发性甲状旁腺功能亢进症（SHPT）的长期疗效和安全性，并确定治疗失败的预测因素。
2014年1月至2023年7月，102例甲状旁腺切除或消融术后复发性或持续性SHPT患者接受了热消融治疗。中位随访期为30个月。主要终点是随访结束时达到目标甲状旁腺激素（PTH）水平（≤300 pg/mL）的参与者比例。次要终点是PTH、钙、磷和碱性磷酸酶（ALP）水平相对于基线的平均变化；技术成功率；以及并发症情况。进行单因素和多因素逻辑回归分析以确定影响消融预后的独立预后因素。
共评估了102名参与者（平均年龄52±12岁），其增生的甲状旁腺有174个。总体而言，87.3%的参与者达到了目标PTH水平。与基线相比，PTH、钙、磷和ALP水平显著降低（p<0.05）。技术成功率为100%。对于主要并发症，1名（1.0%）参与者在消融后出现持续性喉返神经麻痹，29名参与者发生严重低钙血症，但补充钙剂后未导致严重合并症。治疗失败的唯一独立预测因素是基线PTH≥1606 pg/mL（比值比，5.1；95%置信区间：1.1 - 23.1；p = 0.04）。
超声引导下热消融治疗复发性或持续性SHPT安全有效。基线PTH≥1606 pg/mL是治疗失败的关键预测因素。
问题 复发性/持续性SHPT缺乏安全、微创的治疗方法，而传统的再次手术因纤维化和解剖结构改变导致并发症风险高。发现 该研究显示达到目标PTH水平的比例为87.3%。严重低钙血症的发生率达到28.4%。临床意义 这项具有大样本量的开创性多中心研究证明了超声引导下经皮热消融治疗复发性和持续性SHPT的长期有效性和安全性。它为管理这种疾病提供了一种可行的非手术替代方案。
