{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T22:42:20Z","timestamp":1790980940296,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T00:00:00Z","timestamp":1640044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: preoperative differentiation of enlarged parathyroid glands may be challenging in conventional B-mode ultrasound. The aim of our study was to analyse qualitative and quantitative characteristics of parathyroid gland lesions, using multiparametric ultrasound protocol\u2014B-mode, Colour Doppler (CD), and contrast-enhanced ultrasound (CEUS)\u2014and to evaluate correlation with morphology in patients with hyperparathyroidism (HPT). Materials and Methods: consecutive 75 patients with 88 parathyroid lesions and biochemically confirmed HPT prior to parathyroidectomy were enrolled in the prospective study. B-mode ultrasound, CD, and CEUS were performed with the subsequent qualitative and quantitative evaluation of acquired data. We used 1 mL or 2 mL of intravenous ultrasound contrast agent during the CEUS examination. Correlation with post-surgical morphology was evaluated. Results: seventy parathyroid adenomas were hypoechoic and well contoured with increased central echogenicity (44.3%), peripheral-central vascularization (47%), and polar feeding vessel (100%). Twelve hyperplasias presented with similar ultrasound appearance and were smaller in volume (p = 0.036). Hyperplasias had a tendency for homogenous, marked intense enhancement vs. peripherally enhanced adenomas with central wash-out in CEUS after quantitative analysis. No significant difference was observed in contrasting dynamics, regardless of contrast media volume use (1 mL vs. 2 mL). We achieved 90.9% sensitivity and 72.7% specificity, 93% positive predictive value (PPV), 87.3% negative predictive value (NPV), and 87.3% accuracy in the differentiation of parathyroid lesions prior to post-processing. In a quantitative lesion analysis, our sensitivity increased up to 98%, specificity 80%, PPV 98%, and NPV 80% with an accuracy of 96.4%. Conclusions: CEUS of parathyroid lesions shows potential in the differentiation of adenoma from hyperplasia, regardless of the amount of contrast media injected. The quantitative analysis improved the sensitivity and specificity of differentiation between parathyroid lesions. Hyperplasia was characterized by homogeneous enhancement, fast uptake, and homogeneous wash-out appearance; adenoma\u2014by peripheral uptake, central wash-out, and reduced hemodynamics. The use of CEUS quantification methods are advised to improve the ultrasound diagnostic role in suspected parathyroid lesions.<\/jats:p>","DOI":"10.3390\/medicina58010002","type":"journal-article","created":{"date-parts":[[2021,12,21]],"date-time":"2021-12-21T09:50:43Z","timestamp":1640080243000},"page":"2","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Contrast-Enhanced Ultrasound Qualitative and Quantitative Characteristics of Parathyroid Gland Lesions"],"prefix":"10.3390","volume":"58","author":[{"given":"Sergejs","family":"Pavlovics","sequence":"first","affiliation":[{"name":"Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-4855","authenticated-orcid":false,"given":"Maija","family":"Radzina","sequence":"additional","affiliation":[{"name":"Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"},{"name":"Faculty of Medicine, University of Latvia, LV-1586 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Niciporuka","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5674-7240","authenticated-orcid":false,"given":"Madara","family":"Ratniece","sequence":"additional","affiliation":[{"name":"Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madara","family":"Mikelsone","sequence":"additional","affiliation":[{"name":"Department of Statistics, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elina","family":"Tauvena","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Riga Stradins University, LV-1007 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mara","family":"Liepa","sequence":"additional","affiliation":[{"name":"Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peteris","family":"Prieditis","sequence":"additional","affiliation":[{"name":"Radiology Research Laboratory, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arturs","family":"Ozolins","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janis","family":"Gardovskis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2412-7722","authenticated-orcid":false,"given":"Zenons","family":"Narbuts","sequence":"additional","affiliation":[{"name":"Department of Surgery, Riga Stradins University, LV-1007 Riga, Latvia"},{"name":"Department of Surgery, Pauls Stradins Clinical University Hospital, LV-1002 Riga, Latvia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,21]]},"reference":[{"key":"ref_1","first-page":"123","article-title":"The coexistence of primary hyperparathyroidism and thyroid nodules: Should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?","volume":"37","author":"Scerrino","year":"2016","journal-title":"Il G. Di Chir."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/nrendo.2017.104","article-title":"Primary hyperparathyroidism","volume":"14","author":"Walker","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1007","DOI":"10.1016\/j.path.2019.08.006","article-title":"Parathyroid Pathology","volume":"12","author":"Guilmette","year":"2019","journal-title":"Surg. Pathol. Clin."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"391","DOI":"10.4103\/ijem.IJEM_292_19","article-title":"Secondary and tertiary hyperparathyroidism in chronic kidney disease: An endocrine and renal perspective","volume":"23","author":"Chandran","year":"2019","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1056\/NEJMcp1714213","article-title":"Primary Hyperparathyroidism","volume":"379","author":"Insogna","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"95","DOI":"10.3233\/CH-2011-1402","article-title":"Evaluation of the microvascularization of pathologic parathyroid glands in patients with primary hyperparathyroidism using conventional ultrasound and contrast-enhanced ultrasound","volume":"48","author":"Uller","year":"2011","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"268","DOI":"10.14366\/usg.14071","article-title":"Parathyroid ultrasonography: The evolving role of the radiologist","volume":"34","author":"Sung","year":"2015","journal-title":"Ultrasonography"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"386","DOI":"10.11152\/mu-1089","article-title":"The diagnostic value of shear wave elastography for parathyroid lesions and comparison with cervical lymph nodes","volume":"19","author":"Polat","year":"2017","journal-title":"Med. Ultrason."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4829","DOI":"10.21037\/jtd.2019.11.29","article-title":"A new tool for diagnosing parathyroid lesions: Angio plus ultrasound imaging","volume":"11","author":"Liu","year":"2019","journal-title":"J. Thorac. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1507\/endocrj.EJ11-0351","article-title":"The role of colour Doppler ultrasonography in the preoperative localization of parathyroid adenomas","volume":"59","author":"Mohammadi","year":"2012","journal-title":"Endocr. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1586","DOI":"10.1016\/j.ejrad.2016.06.009","article-title":"Shear wave elastography and parathyroid adenoma: A new tool for diagnosing parathyroid adenomas","volume":"85","author":"Azizi","year":"2016","journal-title":"Eur. J. Radiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/JMU.JMU_28_18","article-title":"Progress in the ultrasonographic microvascular imaging","volume":"26","author":"Yen","year":"2018","journal-title":"J. Med. Ultrasound"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1055\/a-0586-1107","article-title":"The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)","volume":"39","author":"Sidhu","year":"2018","journal-title":"Ultraschall Med. Eur. J. Ultrasound"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"562","DOI":"10.1055\/a-1177-0530","article-title":"Guidelines and Good Clinical Practice Recommendations for Contrast Enhanced Ultrasound (CEUS) in the Liver\u2014Update 2020\u2014WFUMB in Cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS","volume":"41","author":"Dietrich","year":"2020","journal-title":"Ultraschall Med. Eur. J. Ultrasound"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"102819","DOI":"10.1016\/j.amjoto.2020.102819","article-title":"Pre-operative imaging workup for surgical intervention in primary hyperparathyroidism: A tertiary referral center experience","volume":"42","author":"Piccin","year":"2021","journal-title":"Am. J. Otolaryngol."},{"key":"ref_16","first-page":"410","article-title":"Minimally invasive parathyroid surgery","volume":"4","author":"Noureldine","year":"2015","journal-title":"Gland. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2478\/raon-2020-0010","article-title":"Surgical options in treating patients with primary hyperparathyroidism","volume":"54","author":"Majcen","year":"2020","journal-title":"Radiol. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1055\/s-0032-1313026","article-title":"An EFSUMB Introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for Quantification of Tumour Perfusion","volume":"33","author":"Dietrich","year":"2012","journal-title":"Ultraschall Med. Eur. J. Ultrasound"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1055\/s-0032-1312894","article-title":"Perfusion Quantification in Contrast-Enhanced Ultrasound (CEUS)\u2014Ready for Research Projects and Routine Clinical Use","volume":"33","author":"Tranquart","year":"2012","journal-title":"Ultraschall Med. Eur. J. Ultrasound"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1055\/s-0041-103847","article-title":"Qusantitative perfusion analysis in pancreatic contrast enhanced ultrasound (DCE-US): A promising tool for the differentiation between autoimmune pancreatitis and pancreatic cancer","volume":"53","author":"Vitali","year":"2015","journal-title":"Z. F R Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.mric.2017.08.009","article-title":"Update in Parathyroid Imaging","volume":"26","author":"Kuzminski","year":"2018","journal-title":"Magn. Reson. Imaging Clin. N. Am."},{"key":"ref_22","first-page":"100065","article-title":"Optimal imaging modality for diagnosis of parathyroid adenoma: Case report and review of the literature","volume":"17","author":"Tsai","year":"2020","journal-title":"J. Clin. Transl. Endocrinol. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1530\/EC-19-0443","article-title":"Ultrasound elastography score and strain index in different parathyroid lesions","volume":"8","author":"Cakir","year":"2019","journal-title":"Endocr. Connect."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"139","DOI":"10.11152\/mu.2013.2066.172.tka","article-title":"Variable sonographic spectrum of parathyroid adenoma with a novel ultrasound finding: Dual concentric echo sign","volume":"17","author":"Acar","year":"2015","journal-title":"Med. Ultrason."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Ferraro, V., Sgaramella, L.I., Di Meo, G., Prete, F.P., Logoluso, F., Minerva, F., Noviello, M., Renzulli, G., Gurrado, A., and Testini, M. (2019). Current concepts in parathyroid carcinoma: A single Centre experience. BMC Endocr. Disord., 19.","DOI":"10.1186\/s12902-019-0368-1"},{"key":"ref_26","first-page":"17577","article-title":"Primary Hyperparathyroidism Secondary to a Sestamibi-Negative Cystic Parathyroid Adenoma","volume":"13","author":"Win","year":"2021","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S78","DOI":"10.1038\/modpathol.2010.132","article-title":"Parathyroid tumors and related disorders","volume":"24","author":"DeLellis","year":"2011","journal-title":"Mod. Pathol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"594","DOI":"10.21614\/chirurgia.114.5.594","article-title":"Clinical Aspects of Parathyroid Hyperplasia in Secondary Renal Hyperparathyroidism","volume":"114","author":"Pasnicu","year":"2019","journal-title":"Chirurgia"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1007\/s40477-018-0332-3","article-title":"Actual role of color-doppler high-resolution neck ultrasonography in primary hyperparathyroidism: A clinical review and an observational study with a comparison of 99mTc-sestamibi parathyroid scintigraphy","volume":"22","author":"Vitetta","year":"2019","journal-title":"J. Ultrasound"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"578","DOI":"10.3174\/ajnr.A3715","article-title":"Prevalence of the Polar Vessel Sign in Parathyroid Adenomas on the Arterial Phase of 4D CT","volume":"35","author":"Bahl","year":"2013","journal-title":"Am. J. Neuroradiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000442273","article-title":"Sonography of Normal and Abnormal Thyroid and Parathyroid Glands","volume":"45","author":"Andrioli","year":"2016","journal-title":"Imaging Endocr. Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1001\/jamaoto.2018.1671","article-title":"Preoperative Imaging Techniques in Primary Hyperparathyroidism","volume":"144","author":"Bunch","year":"2018","journal-title":"JAMA Otolaryngol. Neck Surg."},{"key":"ref_33","first-page":"TC01","article-title":"Role of Gray Scale, Color Doppler and Spectral Doppler in Differentiation between Malignant and Benign Thyroid Nodules","volume":"10","author":"Palaniappan","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_34","first-page":"9819","article-title":"Evaluation of B-Mode and Color Doppler Ultrasound in the Diagnosis of Malignant Cervical Lymphadenopathy","volume":"12","author":"Rohan","year":"2020","journal-title":"Cureus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"423","DOI":"10.3233\/CH-189307","article-title":"VueBox\u00ae perfusion analysis of contrast-enhanced ultrasound (CEUS) examinations in patients with primary hyperparathyroidism for preoperative detection of parathyroid gland adenoma","volume":"70","author":"Jung","year":"2019","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2565","DOI":"10.1002\/jum.14949","article-title":"\u00c1lvarez Potential Utility of Contrast-Enhanced Ultrasound in the Preoperative Evaluation of Primary Hyperparathyroidism","volume":"38","author":"Hernando","year":"2019","journal-title":"J. Ultrasound Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"972","DOI":"10.3389\/fonc.2020.00972","article-title":"Role of Contrast-Enhanced Ultrasound (CEUS) in the Diagnosis of Cervical Lymph Node Metastasis in Nasopharyngeal Carcinoma (NPC) Patients","volume":"10","author":"Ling","year":"2020","journal-title":"Front. Oncol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4850","DOI":"10.3748\/wjg.v19.i30.4850","article-title":"New ultrasound techniques for lymph node evaluation","volume":"19","author":"Cui","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/jum.15074","article-title":"Value of Qualitative and Quantitative Contrast-Enhanced Ultrasound Analysis in Preoperative Diagnosis of Cervical Lymph Node Metastasis from Papillary Thyroid Carcinoma","volume":"39","author":"Chen","year":"2020","journal-title":"J. Ultrasound Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Radzina, M., Ratniece, M., Putrins, D.S., Saule, L., and Cantisani, V. (2021). Performance of Contrast-Enhanced Ultrasound in Thyroid Nodules: Review of Current State and Future Perspectives. Cancers, 13.","DOI":"10.3390\/cancers13215469"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1210\/jc.2013-1007","article-title":"Highly Efficient Localization of Pathological Glands in Primary Hyperparathyroidism Using Contrast-Enhanced Ultrasonography (CEUS) in Comparison with Conventional Ultrasonography","volume":"98","author":"Agha","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"64","DOI":"10.4103\/2156-7514.103054","article-title":"Does Contrast-Enhanced Cervical Ultrasonography Improve Preoperative Localization Results in Patients with Sporadic Primary Hyperparathyroidism?","volume":"2","author":"Karakas","year":"2012","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"515","DOI":"10.3233\/CH-131800","article-title":"The role of contrast-enhancend ultrasonography (CEUS) in comparison with 99mTechnetium-sestamibi scintigraphy for localization diagnostic of primary hyperparathyroidism","volume":"58","author":"Agha","year":"2014","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"35","DOI":"10.3233\/CH-190723","article-title":"The role of preoperative ultrasound, contrast-enhanced ultrasound, and 99mTc-MIBI scanning with single-photon emission computed tomography\/X-ray computed tomography localization in refractory secondary hyperparathyroidism","volume":"75","author":"Li","year":"2020","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"E2159","DOI":"10.1002\/hed.24027","article-title":"Detection rate of 99m Tc-MIBI single photon emission computed tomography (SPECT)\/CT in preoperative planning for patients with primary hyperparathyroidism: A meta-analysis","volume":"38","author":"Treglia","year":"2016","journal-title":"Head Neck"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/2\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:50:21Z","timestamp":1760169021000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/1\/2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,21]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,1]]}},"alternative-id":["medicina58010002"],"URL":"https:\/\/doi.org\/10.3390\/medicina58010002","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,21]]}}}