Abstract
Introduction.Recently, surgeons have been using minimally invasive methods to treat parathyroid gland pathology. More selective surgical approaches are based on the accuracy of preoperative diagnostic methods. Various radiological diagnostic techniques are used to visualize parathyroid gland pathology. New modalities are entering clinical practice along with long-known techniques. The attending physician should be guided by the most clinically effective and economically reasonable algorithm when choosing diagnostic algorithm.The aim of the studywas to find the optimal diagnostic protocol for preoperative diagnosis of parathyroid gland pathology on the basis of available data.Conclusion.Preoperative imaging of parathyroid glands continues to evolve with changes of old techniques and appearance of new ones, though none of modalities has a clear advantage. The choice of imaging algorithm is largely based on the availability of techniques and the experience of particular diagnostic centers. Ultrasound and planar scintigraphy are well established and most widely used. The combination of these techniques remains the first line of diagnosis in preoperative imaging. However, there is no consensus on the choice between planar scintigraphy tech niques: the washout method or the subtraction method. Replacing planar scintigraphy with SPECT/CT improves the detectability of pathological masses and clarifies their topographic location. Computed tomography and MRI techniques are used as a second-line technique and have an advantage in small adenoma sizes, multiple lesions, ectopias, reoperations, and in case of ambiguous ultrasound and scintigraphy data. The significance of PET/CT in the diagnosis of thyroid pathology has not yet been defined, the data are still scarce and published studies are very heterogeneous, but due to the excellent diagnostic characteristics the method seems very promising, in particular in patients with persistent disease.
Highlights
Surgeons have been using minimally invasive methods to treat parathyroid gland pathology
There is no consensus on the choice between planar scintigraphy techniques: the washout method or the subtraction method
Replacing planar scintigraphy with SPECT/CT improves the detectability of pathological masses and clarifies their topographic location
Summary
ПРЕДОПЕРАЦИОННАЯ ДИАГНОСТИКА ПАТОЛОГИИ ПАРАЩИТОВИДНЫХ ЖЕЛЕЗ МЕТОДАМИ ЛУЧЕВОЙ ДИАГНОСТИКИ. В последнее время хирурги используют минимально инвазивные методы лечения патологии паращитовидных желез. Для визуализации патологии паращитовидных желез используются различные методы лучевой диагностики. Цель исследования: поиск оптимального диагностического протокола для предоперационной диагностики патологии паращитовидных желез на основе имеющихся доступных данных. Предоперационная визуализация паращитовидных желез продолжает развиваться с изменением старых методик и появлением новых, хотя при этом ни одна из модальностей не обладает явным преимуществом. Сочетание этих методов остается первой линией диагностики в предоперационной визуализации. Тем не менее нет консенсуса по выбору между методиками планарной сцинтиграфии: метод вымывания или метод субтракции. Компьютерная и магнитно-резонансная томография используются как вторая линия и обладают преимуществом при малых размерах аденом ПЩЖ, множественном поражении, эктопии, при повторных операциях, а также в случае неоднозначных данных УЗИ и сцинтиграфии. Ключевые слова: ПЩЖ, ПГПТ, УЗИ, МРТ, КТ, ОФЭКТ/КТ, ПЭТ/КТ, метод вымывания, метод субтракции. PREOPERATIVE DIAGNOSIS OF PARATHYROID GLAND PATHOLOGY BY METHODS OF RADIOLOGICAL DIAGNOSTICS
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