Abstract:

Aim: was to determine possibilities of ultrasound in estimation of the status of parathyroid glands (PTG) in patients with secondary hyperparathyroidism (SHPT) treated with percutaneous ethanol injections.

Materials and methods: we examined 200 patients with end-stage of renal disease on dialysis. Enlargement and structural alteration of PTG were noted in 125 patients (62,5 %). Higher level of intact parathyroid hormone (iPTH) over 300 pg/ml was noted in the majority of patients with diagnosed parathyroic hyperplasia (81,6 %). Percutaneous ethanol injection therapy under ultrasound guidance was performed in 13 patients with SHPT resistant to medical therapy Average number of injections was 2,8 (from 1 to 6). Treatment effect was assessed based on iPTH level, calcium-phosphorus product level, as well as ultrasound evaluation.

Results: statistically significant decrease of iPTH after injections was noted averaging by 57,3% (p=0,0007), calcium-phosphorus product - by 12,2% (p=0,003). The biggest effect was noted in case of single hyperplastic PTG. During the follow-up, tendency to continued decreasing in levels of iPTH remained in 61,5 %. Decrease of the largest dimension of PTG after ethanol injections was noted on average by 15,1%, decrease of volume by 31,6%. Significant decrease in systolic velocity as well as resistive index of the feeding artery of PTG were observed (p=0,001 and 0,03 respectively). An important sign of diminished functional activity in the injected gland was statistically significant decrease in the vascularization index as assessed by the color Doppler during the process of injections (p=0,002).

Conclusion: ultrasound method provides information necessary for patients' selection for conduction of percutaneous ethanol injection therapy It assists at the time of the manipulation as well as during the follow-up assessing the condition of PTG and effectiveness of treatment. 

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