Objective To analyze the clinical value of ultrasound strain elastography in preoperative evaluation of hyperplasia lesions in patients with secondary hyperparathyroidism (SHPT).
Methods Fifty patients with maintenance hemodialysis who underwent parathyroid surgery in the Renal Disease Center of the Second Affiliated Hospital of Nanjing Medical University were enrolled in this study. A total of 196 hyperplasia lesions were detected by ultrasonography, among which 190 lesions confirmed by pathological examination as parathyroid hyperplasia were divided into group A (n=147, diameter of single hyperplasia gland ≥10 mm) and group B (n=43, diameter of single hyperplasia gland < 10 mm). The elastic strain rate ratio (SR) of the glands was obtained by routine ultrasound and elastography analysis. The correlation between SR and diameter was analyzed. The differences of SR in glands with different echo and blood flow grading were compared.
Results A total of 196 parathyroid glands were detected as abnormal lesions by ultrasound in 50 patients, and 190 parathyroid hyperplasia lesions were confirmed by pathological examination, with a consistent rate of 96.94%(190/196). Another 6 lesions contained other tissue components were misdiagnosed, with a misdiagnosis rate of 3.06%(6/196). Preoperative elastography of the glands in 50 patients revealed that mean SR was (2.67±1.23), and SR was positively correlated with the maximum diameter of the gland (r=0.21, P < 0.05). The mean SR in group A was (2.82±1.21), which was significantly higher than (2.16±1.17) of group B (P < 0.05). There was significant difference in SR between hypoechoic and isoechoic or hyperechoic glands (P < 0.05). The diameter of the parathyroid gland with hyperplasia had positive correlation with parathyroid hormone (PTH) (r=0.21, P < 0.05), and no correlation with serum calcium, phosphorus and alkaline phosphatase (P>0.05).
Conclusion Elastography has a high detection rate of parathyroid lesions in patients with SHPT, which can be used for preoperative localization and screening, and can be used as a powerful supplement to conventional ultrasound examination. The diameter of parathyroid gland reflects the severity of SPHT.
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