继发性甲状旁腺功能亢进的超声影像

目的：探讨继发性甲状旁腺功能亢进（甲旁亢）时甲状旁腺增生的声像表现。方法：对59例合并有甲旁亢的慢性肾衰患进行甲状旁腺高频超声检查，对其中3例患的甲状旁腺在超声引导下穿刺活检，总结甲状旁腺增生的超声表现，并与活检病理结果对照。结果：（1）继发性甲旁亢时增大的甲状旁腺超声检出率为83．1％（49／59），其中93．9％（46／49）的患只能检出1－2枚增大的腺体；（2）甲状旁腺有5种主要超声表现，以腺体内部低回声和腺体内多发性环形钙化灶为特征性改变；1（3）1例患在1个甲状旁腺内出现腺瘤强回声和增生低回声共存；（4）1例肾移植术后患的移植肾内发生甲旁亢性结石，即三发性甲旁亢。结论：继发性甲旁亢时甲状旁腺的高频超声检查敏感，特异，是继发清甲状旁腺激素和血清钙测定之后的又一个有价值的诊断和评价方法，可以作为慢性肾衰患是否已有或将有甲旁亢的普查手段。

Ultrasonography of secondary hyperparathyroidism

Objective: To investigate the ultrasonographic features of hyperplastic parathyroid glands in patients with secondary hyperparathyroidism. Methods: Fifty-nine uremic patients accompanied with hyperparathyroidism underwent high resolution parathyroid ultrasonography. On 3 of them ultrasound-guided parathyroid biopsies were performed. The ultrasonographic manifestations of the hyperplastic parathyroids were compared with the optical histology from biopsy. Results :(1) The overall detection rate of parathyroid glands was 83.1% by high resolution ultrasonography, and among those 93. 9% were found to have 1 to 2 glands detectable. (2) Five kinds of manifestations were found, among which the homogeneous internal hypoechoes and multiple hyperechoic rings of calcification in the parathyroid parenchyma were characteristic. (3) One patient showed coexistence of adenoma hyperechoes and hyperplasia hypoechoes in a single parathyroid gland. (4) Lithonephria occured in the transplanted kidney in a patient received renal treated by a successful transplantation, which was indicative of tertiary hyperparathyroidism. Conclusion: High resolution ultrasonography is sensitive and specific to detect the abnormalities of parathyroid glands in the patients with secondary hyperparathyroidism. It is complementary to the laboratory tests of serum parathyroid hormone and serum calcium, and it is valuable for the diagnosis and followup evaluation of hyperparathyroidism. It may be used for the screening of presence or future development of secondary hyperparathyroidism in uremic candidates.