The Ability of Contrast-Enhanced Ultrasound, Conventional Ultrasound, and 99mTc-MIBI Scintigraphy for the Detection of Parathyroid Lesion in Patients with Primary Hyperparathyroidism

REVIEW
Maryam M. Alramadhan, A. Alsolai, Rana A. Eisa, Awadia Gareeballah

 
International Journal of Biomedicine. 2022;12(1):82-88.
DOI: 10.21103/Article12(1)_RA3
Originally published March 10, 2022

Abstract: 

The aim of this review was to compare the efficiency of conventional ultrasound (CUS), contrast-enhanced ultrasound (CEUS), and 99mTc-MIBI scintigraphy in imaging parathyroid gland lesions in patients with  primary hyperparathyroidism (PHPT).
In this review, we attempted to present a clear view of the most reliable or precise technique for detecting parathyroid gland (PG) pathology in PHPT. Our study relied on secondary data based on the review of the extant literature on PHPT imaging. The research retrieved articles from the scholarly databases Google Scholar, Web of Science, and PUBMED/MEDLINE that examine the efficiency of CUS, CEUS, and 99mTc-MIBI scintigraphy in imaging PGs in PHPT patients. The study retrieved secondary data from past research identified using keyword and medical subject heading terms like "Ultrasound," "Contrast-Enhanced Ultrasound," "Sonography in parathyroid," "Primary hyperthyroidism," "Scintigraphy," and "Contrast-enhanced ultrasound in parathyroid disease." This study only relied on original contribution papers presented in English and published between 2011 and 2021.
We found that CEUS has a comparable sensitivity to 99mTc-MIBI scintigraphy so that it can be used in patients who have a contraindication to scintigraphy or in a hospital without nuclear medicine facility. CEUS is able to detect very small size adenomas, whereas the detection using scintigraphy depends on the size of the diseased glands and the cytology.

Keywords: 
contrast-enhanced ultrasound • conventional ultrasound • primary hyperparathyroidism • scintigraphy
References: 
  1. Walker MD, Bilezikian JP. Primary Hyperparathyroidism. 2021 Apr 19. In: Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dhatariya K, Dungan K, Hershman JM, Hofland J, Kalra S, Kaltsas G, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, Morley JE, New M, Purnell J, Sahay R, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905161.
  2. Vaidya A, Curhan GC, Paik JM, Wang M, Taylor EN. Body Size and the Risk of Primary Hyperparathyroidism in Women: A Cohort Study. J Bone Miner Res. 2017 Sep;32(9):1900-1906. doi: 10.1002/jbmr.3168. 
  3. Paik JM, Curhan GC, Taylor EN. Calcium intake and risk of primary hyperparathyroidism in women: prospective cohort study. BMJ. 2012 Oct 17;345:e6390. doi: 10.1136/bmj.e6390.
  4. Golden SH, Robinson KA, Saldanha I, Anton B, Ladenson PW. Clinical review: Prevalence and incidence of endocrine and metabolic disorders in the United States: a comprehensive review. J Clin Endocrinol Metab. 2009 Jun;94(6):1853-78. doi: 10.1210/jc.2008-2291. 
  5. Bilezikian JP, Bandeira L, Khan A, Cusano NE. Hyperparathyroidism. Lancet. 2018 Jan 13;391(10116):168-178. doi: 10.1016/S0140-6736(17)31430-7. 
  6. Johnson NA, Tublin ME, Ogilvie JB. Parathyroid imaging: technique and role in the preoperative evaluation of primary hyperparathyroidism. AJR Am J Roentgenol. 2007 Jun;188(6):1706-15. doi: 10.2214/AJR.06.0938.
  7. Parra Ramírez P, Santiago Hernando A, Barquiel Alcalá B, Martín Rojas-Marcos P, Lisbona Catalán A, Álvarez Escolá C. Potential Utility of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Primary Hyperparathyroidism. J Ultrasound Med. 2019 Oct;38(10):2565-2571. doi: 10.1002/jum.14949. 
  8. Uller W, Jung EM, Hornung M, Ross C, Jung W, Schlitt HJ, Stroszczynski C, Agha A. Evaluation of the microvascularization of pathologic parathyroid glands in patients with primary hyperparathyroidism using conventional ultrasound and contrast-enhanced ultrasound. Clin Hemorheol Microcirc. 2011;48(1):95-103. doi: 10.3233/CH-2011-1402. 
  9. Agha A, Hornung M, Rennert J, Uller W, Lighvani H, Schlitt HJ, Jung EM. Contrast-enhanced ultrasonography for localization of pathologic glands in patients with primary hyperparathyroidism. Surgery. 2012 Apr;151(4):580-6. doi: 10.1016/j.surg.2011.08.010. 
  10. Agha A, Hornung M, Stroszczynski C, Schlitt HJ, Jung EM. Highly efficient localization of pathological glands in primary hyperparathyroidism using contrast-enhanced ultrasonography (CEUS) in comparison with conventional ultrasonography. J Clin Endocrinol Metab. 2013 May;98(5):2019-25. doi: 10.1210/jc.2013-1007. 
  11. Navarro SM, Malhi H, Deurdulian C, Grant E. Localization of Parathyroid Adenoma Using Contrast-Enhanced Sonography. J Ultrasound Med. 2019 Jan;38(1):259-260. doi: 10.1002/jum.14672. 
  12. Hornung M, Jung EM, Stroszczynski C, Schlitt HJ, Agha A. Contrast-enhanced ultrasonography (CEUS) using early dynamic in microcirculation for localization of pathological parathyroid glands: first-line or complimentary diagnostic modality? Clin Hemorheol Microcirc. 2011;49(1-4):83-90. doi: 10.3233/CH-2011-1459. 
  13. Platz Batista da Silva N, Jung EM, Jung F, Schlitt HJ, Hornung M. VueBox® perfusion analysis of contrast-enhanced ultrasound (CEUS) examinations in patients with primary hyperparathyroidism for preoperative detection of parathyroid gland adenoma. Clin Hemorheol Microcirc. 2018;70(4):423-431. doi: 10.3233/CH-189307. 
  14. Piccin O, D'Alessio P, Cioccoloni E, Burgio L, Poggi C, Altieri P, Vicennati V, Repaci A, Pagotto U, Cavicchi O. Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience. Am J Otolaryngol. 2021 Jan-Feb;42(1):102819. doi: 10.1016/j.amjoto.2020.102819. 
  15. Karakas E, Kann S, Höffken H, Bartsch DK, Celik I, Görg C, Pfestroff A. Does contrast-enhanced cervical ultrasonography improve preoperative localization results in patients with sporadic primary hyperparathyroidism? J Clin Imaging Sci. 2012;2:64. doi: 10.4103/2156-7514.103054. 
  16. Ruda JM, Hollenbeak CS, Stack BC Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg. 2005 Mar;132(3):359-72. doi: 10.1016/j.otohns.2004.10.005.
  17. Abd Elhameed Elsayed W, Ali RA. Efficacy of Scintigraphy, Ultrasound and Both Scintigraphy and Ultrasonography in Preoperative Detection and Localization of Primary Hyperparathyroidism. Cureus. 2019 Jun 20;11(6):e4960. doi: 10.7759/cureus.4960.
  18. Argirò R, Diacinti D, Sacconi B, Iannarelli A, Diacinti D, Cipriani C, Pisani D, Romagnoli E, Biffoni M, Di Gioia C, Pepe J, Bezzi M, Letizia C, Minisola S, Catalano C. Diagnostic accuracy of 3T magnetic resonance imaging in the preoperative localisation of parathyroid adenomas: comparison with ultrasound and 99mTc-sestamibi scans. Eur Radiol. 2018 Nov;28(11):4900-4908. doi: 10.1007/s00330-018-5437-8. 
  19. Scattergood S, Marsden M, Kyrimi E, Ishii H, Doddi S, Sinha P. Combined ultrasound and Sestamibi scintigraphy provides accurate preoperative localisation for patients with primary hyperparathyroidism. Ann R Coll Surg Engl. 2019 Feb;101(2):97-102. doi: 10.1308/rcsann.2018.0158. 
  20. Vitetta GM, Neri P, Chiecchio A, Carriero A, Cirillo S, Mussetto AB, Codegone A. Role of ultrasonography in the management of patients with primary hyperparathyroidism: retrospective comparison with technetium-99m sestamibi scintigraphy. J Ultrasound. 2014 Jan 31;17(1):1-12. doi: 10.1007/s40477-014-0067-8. 
  21. Ibrahim EAG, Elsadawy ME. Combined Tc-99m sesta MIBI scintigraphy and ultrasonography in preoperative detection and localization of parathyroid adenoma. Egypt J Radiol Nucl Med. 2015;46:937-941. 10.1016/j.ejrnm.2015.07.006
  22. Akbaba G, Berker D, Isik S, Aydin Y, Ciliz D, Peksoy I, Ozuguz U, Tutuncu YA, Guler S. A comparative study of pre-operative imaging methods in patients with primary hyperparathyroidism: ultrasonography, 99mTc sestamibi, single photon emission computed tomography, and magnetic resonance imaging. J Endocrinol Invest. 2012 Apr;35(4):359-64. doi: 10.3275/7764. 
  23. Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, Doherty GM, Herrera MF, Pasieka JL, Perrier ND, Silverberg SJ, Solórzano CC, Sturgeon C, Tublin ME, Udelsman R, Carty SE. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016 Oct 1;151(10):959-968. doi: 10.1001/jamasurg.2016.2310. 
  24. Agha A, Hornung M, Schlitt HJ, Stroszczynski C, Jung EM. The role of contrast-enhancend ultrasonography (CEUS) in comparison with 99mTechnetium-sestamibi scintigraphy for localization diagnostic of primary hyperparathyroidism. Clin Hemorheol Microcirc. 2014;58(4):515-20. doi: 10.3233/CH-131800. 

Download Article
Received November 11, 2021.
Accepted January 17, 2022.
©2022 International Medical Research and Development Corporation.