US elastography, an accessible assisting method in the evaluation of parathyroid gland lesions in patients with eskd with hyperparathyroidism / Eslam Mohamed Abdelmaksoud Abunaeima ; Supervised Hussein Hassan Okasha , Mohamed Momtaz Abdelaziz , Hussien Hassan Samir

Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Internal Medicine

In patients with end stage kidney disease maintained on regular hemodialysis, the normal bone axis is deranged . Most of these patients develop hyperplasia and adenomatous changes of the parathyroid gland (secondary and tertiary hyperparathyroidism).For this condition, medical treatment is the rule , but parathyroidectomy remains necessary for many patients . The standard treatment of bilateral neck exploration and excision of all grossly abnormal glands has changed to a pre-operative exploration using preoperative tests and then plan a focused operation to remove only the affected groups with decreased operative time and lower operative morbidity, minimally invasive parathyroidectomy (MIP).Several imaging techniques presently are available to assess the parathyroid glands and all have tremendous capability in the evaluation and pre-operative localization of the abnormal glands like sonography , MIBI scintigraphy and rarely CT or MRI, with variable degrees of sensitivities and specificities.There is a global trend claiming that MIBI is better than US but numerous studies comparing these techniques suggest similar sensitivities and specificities.MIBI has the advantage in ectopic and atypically located glands especially in the mediastinum , the physiologic information and typing of the parathyroid lesion pathology (adenoma or hyperplasia). However it has some limitations like high costs , needs a longer time for examination (2-3 hours) , requires a specialized center of nuclear medicine and implies an exposure to radiations

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