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.