Shear wave elastography and parathyroid adenoma: A new tool for diagnosing parathyroid adenomas

What is it about?

Besides being a common cause of hypercalcemia, primary hyperparathyroidism is usually identified in conjunction with a solitary parathyroid adenoma. These adenomas are treatable with minimally invasive surgical techniques thanks to accurate pre-operative localization. In an effort to improve the accuracy of such pre-operative methods, shear wave elastography was employed to determine various parathyroid adenoma characteristics and apply those toward treatment. This study evaluates the value of VTIQ-generated shear wave elastography in diagnosing parathyroid adenoma prior to surgery. Patients included in the study were diagnosed with primary hyperparathyroidism through lab testing and had a solitary parathyroid adenoma identified by ultrasound. While parathyroid adenomas can be difficult to diagnose with B-mode ultrasound alone, While a basic ultrasound can be used to identify the adenoma, shear wave elastography (SWE) was utilized because the parathyroid glands contains have a different tissue composition, vascularity pattern, and subsequent tissue stiffness detectable through this method. Comparing these characteristics within all 57 patients in the study demonstrated similarities beneficial to diagnosing adenomas. Parathyroid adenomas were found to have a homogenous texture (same throughout) and lower tissue stiffness than the surrounding thyroid gland. Vascularity pattern was also found to be helpful as the blood vessel source in the parathyroid contributed to determining whether a mass surrounding the parathyroid was an adenoma or a lymph node (note: adenomas have a blood vessel, or polar vessel sign, whereas lymph nodes do not). Of the 57 patients included in the study, 49 had a polar vessel sign, 37 had a homogenous texture, and the tissue stiffness (or shear wave velocity) was lower than that of the surrounding thyroid gland by an average of 0.76 m/s.

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Why is it important?

This information is important because adding VTIQ-generated shear wave elastography to basic ultrasound exam application could lower the necessity of sending patients to have MIBI scans or FNA with PTH washout when ultrasound techniques can diagnose them.