Value of ultrasound and scintigraphy Tc-99 preoperative. In hyperparathyroidism secondary; comparison with / os surgical findings
Keywords:
secondary hyperparathyroidism, diagnostic imagingAbstract
The use and cost-effectiveness of neck scanning
procedures, as we/1 as preoperative evaluation of
secondary hyperparathyroidism, is a matter of controversy
Patients and methods: The retrospective analysis
of 21 consecutive patients in the period ranging
between January 2000 through September 2002
with chronic kidney insufficiency and secondary
hyperparathyroidism. Al/ patients were subject to
neck ultrasound and scintiscan with preoperative
technetium 99m sestamibí for the purpose of locating
pathologic parathyroid glands. Al/ of them
underwent surgery. A comparison was made of
the sensitivity and specificíty of the mentioned studies
with intraoperative findings, and these were
certified by an anatomo-pathologic study.
Results: Eighty-two parathyroid glands were resected
as follows: 4 glands in 17 patients, 3 in 3 patients
and 5 in 1 patient. Ultrasound evidenced 48
out of the total 82 glands (59%). Scíntiscan showed
42 glands (51%). Summation of both methods
showed 64 different glands (78%). In none of those
cases in which surgery found only 3 glands did the
studies show the 4 glands.
Conc/usions: both preoperative evaluation methods
are complementary, and have a very high sensitiveness.
The scintiscan by itself has low sensitivity
and little use. Surgery in experienced hands
managed to identify al/ glands, which had gone
undetected in the preoperative studies.
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