Original Report: Patient-Oriented, Translational Research
Ultrasound Patterns of Parathyroid Glands in Chronic Hemodialysis Patients with Secondary HyperparathyroidismVulpio C.a · Bossola M.a · De Gaetano A.b · Maresca G.b · Di Stasio E.c · Spada P.L.a · Romitelli F.c · Luciani G.a · Castagneto M.a
aIstituto Clinica Chirurgica, bIstituto di Radiologia, cIstituto di Biochimica, Università Cattolica del Sacro Cuore, Roma, Italia
Do you have an account?
- Rent for 48h to view
- Buy Cloud Access for unlimited viewing via different devices
- Synchronizing in the ReadCube Cloud
- Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00
Article / Publication Details
Background: The role ofparathyroid glands (PTG) ultrasonography (US) in hemodialysis patients with secondary hyperparathyroidism (SHPT) is still controversial. The present study aimed at evaluating the relationship between US findings and SHPT degree as well as therapeutic outcome. Methods: Twenty hemodialysis patients with moderate SHPT and 15 with severe SHPT underwent US to assess the PTG number, maximum longitudinal diameter (MLD), structural (1 – hypoechoic, 2 – slight heterogeneous, 3 – high heterogeneous, 4 – nodular) and vascular patterns (1 – slight, 2 – medium and 3 – high). Results: PTG number, MLD and US patterns were correlated with iPTH levels. MLD of patients with moderate or severe SHPT was 7.2 ± 2.3 and 15 ± 5.1 mm (p < 0.001). Most patients with moderate SHPT showed a single PTG with an MLD <9 mm associated with 1–2 structural and vascular pattern, whereas patients with severe SHPT exhibited more than one PTG with MLD >9 mm and 3–4 structural and vascular patterns. Thirteen patients were responders to treatment and 22 nonresponders. In nonresponders, a higher number of PTG was observed as well as higher echostructural and vascular patterns. In 14 patients who underwent parathyroidectomy, no differences were found between PTG US MLD and pathology diameter. All PTG with evidence of 3–4 structural and vascular score at ultrasound showed nodular hyperplasia at pathological examination. Conclusions: The adopted classification of US findings is correlated with SHPT degree and therapeutic outcome and might be an adjunctive predictive method useful to assess the SHPT severity and to plan the therapeutic strategy.
© 2008 S. Karger AG, Basel
- Solbiati L, Giangrande A, De Pra L, Cantù P, Ravetto C: Percutaneous ethanol injection of parathyroid tumors under US guidance: treatment for secondary hyperparathyroidism. Radiology 1985;155:607–610.
- Martinoli C, Pretolesi F, Crespi G: Power Doppler sonography: clinical applications. Eur J Radiol 1998;27(suppl 2):S133–S140.
- Mazzeo S, Caramella D, Lencioni R: Usefulness of echocolor Doppler in differentiating parathyroid lesions from other cervical masses. Eur Radiol 1997;7:90–95.
- Lane MJ, Desser TS, Weigel RJ: Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas. Am J Roentgenol 1998;171:819–823.
- Wolf RJ, Cronan JJ, Monchik JM: Color Doppler sonography: an adjunctive technique in assessment of parathyroid adenomas. J Ultrasound Med 1994;13:303–308.
- McCarron DA, Muther Rs, Lenfesty B, Bennett WM: Parathyroid function in persistent hyperparathyroidism: relationship to gland size. Kidney Int 1982;22:662–670.
- Clark OH, Stark DA, Duh QY, Arnaud CD, Gooding GA: Value of high resolution real-time ultrasonography in secondary hyperparathyroidism. Am J Surg 1985;150:9–17.
- Gooding AW, Clark OH: Use of color Doppler imaging in the distinction between thyroid and parathyroid lesions. Am J Surg 1992;164:51–56.
- Guillem P, Vlaeminck-Guillem V, Dracon M, Noel C, Cussac JF, Huglo D, Proye C: Are preoperative examinations useful in the management of patients with renal hyperparathyroidism? Ann Chir 2006;131:27–33.
- Perie S, Fessi H, Tassart M, Younsi N, Poli I, St Guily JL, Talbot JN: Usefulness of combination of high-resolution ultrasonography and dual-phase dual isotope iodine 123/technetium Tc99m sestamibi scintigraphy for the preoperative localization of hyperplastic parathyroid glands in renal hyperparathyroidism. Am J Kidney Dis 2005;45:344–352.
- Fukagawa M, Kitaoka M, Yi H, Fukuda N, Matsumoto T, Ogata E, Kurokawa K: Serial evaluation of parathyroid size by ultrasonography is another useful marker for the long-term prognosis of calcitriol pulse therapy in chronic dialysis patient. Nephron 1994;68:221–228.
- Fukagawa M, Kitaoka M, Kurokawa K: Value of parathyroid sonography in secondary hyperparathyroidism. Nephrol Dial Transplant 1997;12:2461.
- Fukagawa M, Kitaoka M, Inazawa T, Kurokawa K: Imaging of the parathyroid in chronic renal failure: diagnostic and therapeutic aspects. Curr Opin Nephrol Hypertens 1997;6:349–355.
- Katoh N, Nakayama M, Shigematsu T, Yamamoto H, Sano K, Saito I, Nakano I, Kasai K, Kubo H, Sakai S, Kawaguchi Y, Hosoya T: Presence of sonographically detectable parathyroid glands can predict resistance to oral pulsed-dose calcitriol treatment of secondary hyperparathyroidism. Am J Kidney Dis 2000;35:465–468.
- Okuno S, Ishimura E, Kitatani K, Chou H, Nagasue K, Maekawa K, Izumotani K, Yamakawa T, Imanishi Y, Shoji T, Inaba M, Nishizawa Y: Relationship between parathyroid gland size and responsiveness to maxacalcitol therapy in patients with secondary hyperparathyroidism. Nephrol Dial Transplant 2003;18:2613–2621.
Onoda N, Kurihara S, Sakurai Y, Owada K, Osono E, Adachi H, Suga M, Yoneshima H: Evaluation of blood supply of the parathyroid glands in secondary hyperparathyroidism compared to histopathology. Nephrol Dial Transplant 2003;18(suppl 3):iii34–iii37.
- Pavlovic D, Brzac HT: Prevention and treatment of secondary hyperparathyroidism: Still a challenge for the nephrologist? Nephrol Dial Transplant 2003;18(suppl 5):v45–v46.
- Ahuja AT, Wong KT, Ching ASC, Fung MK, Lau JYW, Yuen EHY, King AD: Imaging for primary hyperparathyroidism – what beginners should know. Clin Radiol 2004;59:967–976.
- Senschenkov A, Staren ED: Ultrasound in head and neck surgery: thyroid, parathyroid and cervical lymph nodes. Surg Clin N Am 2004;84:973–1000.
Onoda N, Kurohara S, Yoneshima H: Usefulness of ultrasonographic power-Doppler imaging of parathyroid hyperplasia in renal hyperparathyroidism. J Am Soc Nephrol 1998;9:569–571.
- Tominaga Y, Tanaka Y, Sato K, Nagasaka T, Takagi H: Histology, pathophysiology, and indications for surgical treatment of renal hyperparathyroidism. Semin Surg Oncol 1997;13:78–86.
- Kakuta T, Fukagawa M, Fujisaki T, et al: Prognosis of parathyroid function after successful percutaneous ethanol injection therapy guided by color Doppler flow mapping in chronic dialysis patients. Am J Kidney Dis 1999;33:109–119.
- Onoda N, Kashiwagi T, Nakamura T, Niitsu Y, Omata M, Kurihara S: Parathyroid interventions for secondary hyperparathyroidism in hemodialyzed patients. Ther Apher Dial 2005;9(suppl):S11–S15.
- Fukagawa M, Kitaoka M, Tominaga Y, Akizawa T, Kurokawa K: Selective percutaneous ethanol injection therapy (PEIT) of parathyroid in chronic dialysis patients – the Japanese strategy. Nephrol Dial Transplant 1999;14:2574–2577.
Kitoaka M: Ultrasonographic diagnosis of parathyroid glands and percutaneous ethanol injection therapy. Nephrol Dial Transplant 2003;18(suppl 3):iii27–iii30.
- Ritz E: Which is the preferred treatment of advanced hyperparathyroidism in a renal patient? II. Early parathyroidectomy should be considered as the first choice. Nephrol Dial Transplant 1994;9:1819–1821.
- Malberti F, Corradi B, Cosci P, Calliada F, Marcelli D, Imbasciati E: Long term effect of intravenous calcitriol therapy on the control of secondary hyperparathyroidism. Am J Kidney Dis 1996;28:704–712.
- Indridason OS, Heath H 3rd, Khosla S, Yohay DA, Quarles LD: Nonsuppressible parathyroid hormone secretion is related to gland size in uremic secondary hyperparathyroidism. Kidney Int 1996;50:1663–1671.
- Rodriguez M, Canalejo A, Garfia B, Aguilera E, Almaden Y: Pathogenesis of refractory hyperparathyroidism. Kidney Int 2002;61(suppl 80):155–160.
- Fukuda N, Tanaka H, Fukagawa M, Kurokawa K, Seino Y: Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients. J Clin Invest 1993;92:1436–1443.
- Parfitt AM: The hyperparathyroidism of chronic renal failure: a disorder of growth. Kidney Int 1997;52:3–9.
- Drueke TB: Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol 2000;11:1141–1152.
- Fukagawa M, Nakanishi S, Kazama JJ: Basic and clinical aspects of parathyroid hyperplasia in chronic kidney disease. Kidney Int 2006;70:S3–S7.
- Lewin E, Olgaard K: Influence of parathyroid mass on the regulation of PTH secretion. Kidney Int 2006;70:S16–S21.
National Kidney Foundation: K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003;42:S1–S202.
- Indridason S, Quarles LD; The Durham Renal Osteodystrophy Study Group: Comparison of treatments for mild secondary hyperparathyroidism in hemodialysis patients. Kidney Int 2000;57:282–292.
- Salem MM: Hyperparathyroidism in the hemodialysis population: a survey of 612 patients. Am J Kidney Dis 1997;29:862–865.
Nakanishi S, Yano S, Nomura R, Tsukamoto T, Shimizu Y, Shin J, Fukagawa M: Efficacy of direct injection of calcitriol into the parathyroid glands in uraemic patients with moderate to severe secondary hyperparathyroidism. Nephrol Dial Transplant 2003;18 (suppl 3):iii47–iii49.
- Tominaga Y, Inaguma D, Matsuoka S, Tahara H, Kukita K, Kurihara S, Onoda N, Tsuruta Y, Tsutsui S, Ohta K, Kuwahara M, Tanaka M, Nishizawa Y: Is the volume of the parathyroid gland a predictor of maxacalcitol response in advanced secondary hyperparathyroidism? Ther Apher Dial 2006;10:761–771.
- Moe S, Chertow GM, Coburn JW, Quarles D, Goodman W, Block GA, Drueke TB, Cunningham J, Sherrard DJ, McCarry LC, Olson K, Turner SA, Martin MJ: Achieving NKF-K/DOQI bone metabolism and disease treatment goals with cinacalcet HCl. Kidney Int 2005;67:760–777.
- Loevner LA: Imaging of the parathyroid glands. Semin Ultrasound CT MR 1996:17:563–575.
- Kamaya A, Quon A, Jeffrey RB: Sonography of the abnormal parathyroid gland. Ultrasound Q 2006;22:253–262.
- Barraclough BM, Barraclough BH: Ultrasound of the thyroid and parathyroid glands. World J Surg 2000;24:158–165.
- Varsamidis K, Varsamidou E, Mavropoulos G: Color Doppler sonography in the detection of parathyroid adenomas. Head Neck 1999;21:648–651.
- Fugakawa M, Kazama JJ, Shigematsu T: Management of patients with advanced secondary hyperparathyroidism – the Japanese approach. Nephrol Dial Transplant 2002;17:1553–1557.
- Lagalla R, Caruso G, Finazzo M: Monitoring treatment response with color and power Doppler. Eur J Radiol 1998;28:S149–S156.
- Pretolesi F, Silvestri E, Di Maio G, Martinoli C, Onetto F, Sala P, Derchi LE: US imaging and color-Doppler in patients undergoing inhibitory therapy with calcitriol for secondary hyperparathyroidism. Eur Radiol 1997;7:721–725.
- Pavlovic D, Tomic Brzac H: US Evaluation of parathyroid hyperplasia. ScientificWorldJournal 2006;6:1599–1608.
Article / Publication Details
Copyright / Drug Dosage / DisclaimerCopyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.