-Original-

Ultrasonographic Detective Flow Imaging for Evaluating Parathyroid Adenoma in Patients with Primary Hyperparathyroidism

Haruki Akasu¹, Tomoo Jikuzono², Mami Matsui², Masaomi Sen², Marie Saitou², Osamu Ishibashi^2,3 and Iwao Sugitani²

¹Department of Endocrine Surgery, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
²Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
³Laboratory of Biological Macromolecules, Department of Applied Life Sciences, Graduate School of Life & Environmental Sciences, Osaka Prefecture University, Osaka, Japan

Background: Detective flow imaging (DFI) is a new imaging technology that displays low-velocity blood flow, which is difficult to visualize on conventional color Doppler ultrasonography (CDU). In this study, we compared the usefulness of DFI with that of CDU and methoxy-isobutyl-isonitrile (MIBI) scintigraphy for detecting parathyroid adenoma (PA) in patients with primary hyperparathyroidism (PHPT).
Methods: From March 2021 to March 2023, 87 PHPT patients underwent surgery, and 66 had a single PA. We performed preoperative conventional ultrasonography with CDU, MIBI scintigraphy, and DFI for 42 patients (5 males and 37 females; mean age: 61.6 ± 15.4 years).
Results: MIBI scintigraphy detected PA in 85.7% (36/42) patients, and both CDU and DFI detected PA in all patients. The rates of vascularity in PA detected by CDU and DFI were 71.4% (30/42) and 85.7% (36/42), respectively. Vascularity was detected by DFI in 6 patients who were negative for vascularity on MIBI scintigraphy. Furthermore, DFI detected blood supply in 6 of the 12 patients with undetectable blood supply on CDU. Fisher's exact test revealed that high or low blood flow, as determined by DFI, was significantly associated with detection of feeding vessels in PA by CDU (P < 0.001).
Conclusions: DFI was useful for preoperative detection of PA blood flow.

J Nippon Med Sch 2024; 91: 227-232

Keywords
detective flow imaging, parathyroid adenoma, color doppler ultrasonography, superb microvascular imaging, primary hyperparathyroidism

Correspondence to
Tomoo Jikuzono, MD, PhD, Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8602, Japan
t-jikuzono@nms.ac.jp

Received, September 15, 2023
Accepted, November 24, 2023