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英文誌(2004-)

Journal of Medical Ultrasonics

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1995 - Vol.22

Vol.22 No.11

Original Article(原著)

(0761 - 0767)

超音波断層法による原発性上皮小体機能亢進症の術前局在診断; 偽陽性, 偽陰性例の検討

Preoperative Localization of Abnormal Parathyroid Glands in Primary Hyperparathyroidism by Ultrasonography: An Analysis of False-Positive and False-Negative Cases

牛山 知己1, 栗田 豊1, 麦谷 荘一1, 神林 知幸1, 増田 宏昭1, 鈴木 和雄1, 藤田 公生1, 田島 惇2, 河邉 香月2, 阿曽 佳郎3

Tomomi USHIYAMA1, Yutaka KURITA1, Soichi MUGIYA1, Tomoyuki KANBAYASHI1, Hiroaki MASUDA1, Kazuo SUZUKI1, Kimio FUJITA1, Atsushi TAJIMA2, Kazuki KAWABE2, Yoshio ASO3

1浜松医科大学泌尿器科, 2東京大学泌尿器科, 3藤枝市立総合病院

1Department of Urology Hamamatsu University School of Medicine, 2Department of Urology Faculty of Medicine, University of Tokyo, 3Fujieda General Hospital

キーワード : False-negative, False-positive, Preoperative localization, Primary hyperparathyroidism, Ultrasonography

We used ultrasonography (US) with a 7.5 MHz transducer to examine 25 patients with primary hyperparathyroidism (PHPT) in order to predict the localization of abnormal parathyroid glands. Twenty-three of thse patients had a single adenoma, 1 had three adenomas, and 1 had a carcinoma. These were eight false-positive findings in 6 patients: five thyroid adenomas, one lymph node, one thymus, and one lobulated thyroid. Only one of the five thyroid adenomas was correctly diagnosed by computed tomography (CT), and scintigraphy with thallium and technetium (RI) changed none of the remainder to a correct diagnosis. On the other hand, seven abnormal glands that were not detected on US examination were found on surgery. Two had been mistaken for thyroid cysts; the other five were impossible to detect by US because of the small size of the parathyroid gland or depth below the surface of the body. Of seven glands, RI revealed three that weighed more than 780 mg; CT detected none of them. We think that thorough training, careful scanning, and complete understanding of neck anatomy are essential for accurate identification of abnormal parathyroid glands with US. RI may prove useful in finding parathyroid adenomas that are overlooked by US and CT.