Strain and shear-wave elastography in parathyroid glands evaluation in patients with secondary hyperparathyroidism (preliminary study)

The aim of the study was to assess the value of ultrasound elastography in the parathyroid glands pathology assessment in patients with secondary hyperparathyroidism, including the differential diagnosis of parathyroid hyperplasia types. A total of 76 patients with chronic kidney disease stage 5, treated with renal replacement therapy, were examined. Parathyroid glands enlargement with structural changes was found in 45 (59.2%) patients (66 parathyroid glands). A multiparametric parathyroid ultrasound (B-mode ultrasound, Color Doppler, strain and shear wave elastography) was performed. Hyperplastic parathyroid glands were mostly soft in strain elastography. Elastographic patterns types I and II were predominant (86.4%). Young’s modulus median in the hyperplastic parathyroid glands was 11.4 kPa, 5-95^th percentiles - 8.0-25.2 kPa, and the lowest - highest values - 7.2-30.2 kPa. Parathyroidectomy was performed in 9 patients. After morphological study of 23 parathyroid glands, diffuse hyperplasia was found in 9 (39.1%) of them and nodular in 14 (60.9%) ones. Significant differences in strain ratio (P = 0.02), Young’s modulus (P = 0.009), and stiffness index (P = 0.012) were found in diffuse type of hyperplasia in compare with nodular. The Young’s modulus median in diffuse parathyroid hyperplasia was 9.9 kPa (7.2-15.2 kPa and 7.2-15.2 kPa), in nodular parathyroid hyperplasia - 13.4 kPa (9.5-30.2 kPa and 9.5-30.2 kPa). There were a significant correlations between Young’s modulus and the largest linear dimension and parathyroid gland volume (r_s = 0.384, P = 0.002 and r_s = 0.326, P = 0.008), Young’s modulus and intensity of parathyroid vascularization (r_s = 0.327, P = 0.010). The significant correlation between elastographic pattern types and types of hyperplasia was found (r_s = 0.677, P <0.001). Ultrasound elastography, as a part of multiparametric parathyroid ultrasound, allows obtaining additional diagnostic information in patients with secondary hyperparathyroidism.

мультипараметрическая ультразвуковая диагностика, ультразвуковая эластография, компрессионная эластография, эластография сдвиговой волной, модуль Юнга, скорость сдвиговой волны, коэффициент эластичности (strain ratio), индекс жесткости (stiffness ratio), паращитовидные железы, вторичный гиперпаратиреоз, multiparametric ultrasound, ultrasound elastography, strain elastography, shear-wave elastography, shear wave velocity, strain ratio, stiffness ratio, parathyroid glands, secondary hyperparathyroidism

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