Abstract
This study evaluates the diagnostic value of two-dimensional shear wave elastography (2 D-SWE) technique in the evaluation of hyperplastic parathyroid glands in cases with secondary and tertiary hyperparathyroidism. A total of 59 patients (end-stage renal disease, under supplemental dialysis program) with visible parathyroid hyperplastic glands on ultrasound, confirmed by biochemical assay and scintigraphy, were enrolled; they were examined on grayscale ultrasound and 2 D shear wave elastography. We determined the elasticity index (EI) in the parathyroid gland, thyroid parenchyma and surrounding muscles, and the elasticity ratio of hyperplastic parathyroid glands compared to muscle, specifically sternocleidomastoid muscle. Patients presented fibrocystic bone disease with secondary hyperparathyroidism induced by end-stage chronic kidney disease; being on prolonged chronic dialysis therapy, they had positive sestamibi scintigraphy and high values of serum parathormone (1141.04 pg/mL). Nodules placed posterior to the thyroid capsule that were cystic, had a hypoechoic aspect, and were homogenous with an independent afferent artery were found. Mean EI in the parathyroid gland was 7.83 kPa, the median value in thyroid parenchyma was 13.76 kPa, and mean muscle EI value was 15.78 kPa. The observed mean parathyroid/muscle SWE ratio was 0.5356 and the value for parathyroid/normal thyroid parenchyma was 0.5995. Using receiver operating characteristic (ROC) analysis, we found that EI below 9.74 kPa correctly identifies parathyroid tissue, with a sensitivity of 94.8%, specificity of 90.7%, and accuracy of 92.26% when compared to normal thyroid tissue. Compared with the muscle tissue, we identified that EI below 9.98 kPa has a sensitivity, specificity, and accuracy of 93.8%, 90.7%, and 91.75%, respectively. Ultrasound elastography is a helpful tool in identifying parathyroid hyperplasia in patients with chronic kidney disease. A cutoff value of 9.98 kPa can be used in 2 D-SWE for accurate diagnosis of parathyroid disease.
Highlights
IntroductionThe incidence and prevalence of chronic kidney disease, including kidney failure requiring renal replacement therapies (RRT) is rising in Europe
Secondary hyperparathyroidism is a prevailing complication of chronic kidney disease (CKD) caused by the disturbance of calcium, phosphate, and vitamin D, with high concentrations of serum parathormone (PTH) leading to high rates of cardiovascular and bone disease [1,2].The incidence and prevalence of chronic kidney disease, including kidney failure requiring renal replacement therapies (RRT) is rising in Europe
The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that screening and management of Secondary hyperparathyroidism (sHPT) should be proposed to all patients starting CKD stage 3 [1,5]
Summary
The incidence and prevalence of chronic kidney disease, including kidney failure requiring renal replacement therapies (RRT) is rising in Europe. Incidence in Europe is estimated at 119 per million population (pmp), the highest incidence is cited in the Czech Republic (232 pmp). Prevalence is reported at 801 per million population, with the highest rate reported in Portugal (1824 pmp) [3]. In the United States, the prevalence of CKD is estimated at around 15% of the total population, and over. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that screening and management of sHPT should be proposed to all patients starting CKD stage 3 [1,5]. The prevalence in Europe of sHPT among patients with requiring RRT is estimated at 43.8% in France, 46.8% in Russia, and 42.9% in the United Kingdom. United States has a prevalence of 54% [6]
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