Role of the parathyroid gland vascularization index in predicting percutaneous ethanol injection efficacy in refractory uremic hyperparathyroidism

Nephron Clin Pract. 2011;117(2):c120-6. doi: 10.1159/000319659. Epub 2010 Aug 6.

Abstract

Aims: To evaluate the role of the quantitative vascularization index (VI) as a measure of the completeness of percutaneous ethanol injection therapy (PEIT).

Methods: A total of 37 dialysis patients with secondary hyperparathyroidism refractory to medical therapy received PEIT. We analyzed the role of a quantitative marker of parathyroid adenoma activity, i.e. VI, flow index and vascular flow index as measured by 3-dimensional Doppler ultrasound with a 3-dimensional histogram software, for all patients before treatment and at 1 month and 6 months after PEIT.

Results: Serum intact parathyroid hormone (i-PTH) level showed a strong positive correlation with the VI both before (p < 0.001) and after (p < 0.001) PEIT. There was no correlation between i-PTH level and the volume of the gland either before (p = 0.697) or after (p = 0.564) PEIT. One month after PEIT, 20 patients (group 1) reached the target of i-PTH ≤ 300 pg/ml and 17 patients (group 2) did not. Group 2 patients had significantly greater VI and i-PTH prior to PEIT than group 1 patients (42.23 ± 8.38 vs. 14.95 ± 8.07, p <0.001 and 1,447 ± 243 vs. 859 ± 231, p < 0.001 respectively).

Conclusion: A higher VI indicates a higher i-PTH, and the VI may be a reliable predictor of the completeness of PEIT.

MeSH terms

  • Chronic Disease
  • Dialysis / adverse effects*
  • Ethanol / administration & dosage*
  • Female
  • Health Status Indicators
  • Humans
  • Hyperparathyroidism, Secondary / diagnostic imaging*
  • Hyperparathyroidism, Secondary / drug therapy*
  • Hyperparathyroidism, Secondary / etiology
  • Image Interpretation, Computer-Assisted / methods*
  • Injections, Subcutaneous
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Treatment Outcome
  • Ultrasonography
  • Uremia / diagnostic imaging*
  • Uremia / drug therapy*
  • Uremia / etiology

Substances

  • Ethanol