BASIC METHODS OF VISUALIZATION OF PARATHYROID GLANDS

A.R AGHAYEVA, R.A. AGAYEV, J.B. MAMED-ZADE, S.Y. YUSIFOV,

L.SH. SAFAROVA

Scientific center of Surgery named after M.A. Topchubashov, Baku, AZERBAIJAN

Despite the improvement of diagnostic methods of detection of various pathologies of the parathyroid glands, so far there are great difficulties in the so-called “topical” diagnosis of abnormal parathyroid glands. In the department of endocrine surgery of SSC named after Topchubasheva 62 patients with primary hyperparathyroidism were observed. 21 of them underwent surgeries since 2002. 16 of them had denoma, 3 – hyperplasia of parathyroid glands, and 1 - a double adenoma and 1 patient histologically detected cancer. Methods of visualization of PTG are divided into noninvasive, invasive and intra-operative. Noninvasive include ultrasound, scintigraphy, RCT, and MRT. Invasive techniques: fine-needle aspiration biopsy, selective arteriography, selective venous blood sampling for the determination of PTG, arterial injection of selenium-methionine. Ultrasound was previously widely used to identify problems of parathyroid glands and only in the last 7-10 years RCT and MRT have become an integral part of the practice of doctors. Given the absence of a characteristic ultrasound – images of parathyroid glands - sonographic diagnosis often becomes difficult. If the parathyroid glands are atypically located, this method is not informative. The complexity of ultrasonogrpahy is often deepened by accompanied nodular and polynodulargoiter, that was observed in 19 patients. Sensitivity of ultrasound is 56-85% and specificity – up to 99%. Ultrasound was also used to detect intraoperative parathyroid glands. In recent years, two-phase scintigraphy of PTG 99mTc-sestamibi, which accumulates in the thyroid and pathologically changed OT within 10 minutes, and remains only in PTG after 1-2 hours, is widely used. Of 21 patients, scintigraphy was performed in 6 patients, 4 cases there was detected adenoma and in 2 - hyperplasia of parathyroid glands. In 16 patients, parathyroid adenoma was detected during CT and in 3 during MRT. However, the methods are less informative with small sizes of PTG, as well as thyroid hyperplasia. Given the above mentioned, at least one reliable confirmation of the presence of pathology of parathyroid glands, is the basis for surgical intervention.

Date: 2014-12-28; view: 808