Comparison of scintigraphy and ultrasound imaging in patients with primary, secondary and tertiary hyperparathyroidism – own experience

BACKGROUND: The imaging techniques most commonly used in the diagnosis of hyperparathyroidisms are ultrasound and scintigraphy. The diagnostic algorithms vary, depending mainly on the population, and experience of physicians. AIM: Aim of the present research was to determine the usefulness of parathyroid scintigraphy and ultrasonography in patients diagnosed for hyperparathyroidism in own material. MATERIAL AND METHOD: In the present research, 96 operated patients with documented primary, secondary and tertiary hyperparathyroidism were retrospectively analyzed. All patients underwent a (99m)Tc hexakis-2-methoxyisobutylisonitrile scintigraphy of the neck with the use of subtraction and two-phase examinations. Ultrasonography of the neck was performed in all the patients in B mode 2D presentation. A total number of 172 parathyroid glands were analyzed. RESULTS: The sensitivity and specificity of scintigraphy was 68% and 60%, respectively. The sensitivity of ultrasound was 49% and specificity 85%. Both techniques allowed visualization of 76 parathyroid glands. Ultrasound revealed 19 glands that were not visible in scintigraphy. Scintigraphy showed 76 parathyroid glands that were not visualized on ultrasound. Having combined the results of scintigraphy and ultrasound, the sensitivity of 76% and specificity of 50% were obtained. Considering the ability to locate the parathyroid glands in both techniques as a positive result, the sensitivity decreased to 37% and specificity rose to 95%. CONCLUSIONS: Scintigraphy showed greater sensitivity than ultrasound in the localization of enlarged parathyroid glands. Ultrasound, in turn, was characterized by a higher specificity. The combined use of scintigraphy and ultrasonography allowed to obtain the specificity of 95%. In the light of obtained results, scintigraphy and ultrasonography are complementary and should be used together.