VALUE OF ULTRASONOGRAPHY, CT AND MR-IMAGING IN THE DIAGNOSES OF PRIMARY HYPERPARATHYROIDISM

Purpose: To evaluate the significance of preoperative Idealization of abnormal parathyroid glands to the surgical outcome in patients with p rimary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The over all diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective loca lization technique with a detection rate of 96%. CT had a lower detect ion rate (78%) but was of particular value for fairly large ectopic ad enomas in the root of the neck. MR imaging was a good confirmatory tes t (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was suffici ent. Combination of all 3 studies, however, alerted the physician to t he presence of disease in more than one gland in 87% of these patients . Conclusion: US, CT and MR imaging followed by surgery performed by a n experienced surgeon provided good clinical results in 39 patients wi th primary hyperparathyroidism. Preoperative localization was especial ly useful in patients with primary parathyroid hyperplasia or multiple adenomas and in patients with ectopic parathyroid adenomas in the roo t of the neck. We recommend identification of all abnormal parathyroid glands prior to surgery.