Ultrasonographic Analysis of Clinical Characteristics and Causes of Misdi-agnosis of Parathyroid Hyperplasia in Patients with Secondary Hyperpara-thyroidism Undergoing Maintenance Hemodialysis

XU Rong; TIAN Hui; WU Yingchun; LYU Kangtai

doi:10.3969/j.issn.1002-3429.2024.10.004

Abstract：Objective To investigate the ultrasonographic characteristics and causes of misdiagnosis of parathyroid hyperplasia in patients with secondary hyperparathyroidism(SHPT)undergoing maintenance hemodialysis.Methods A total of 190 patients with SHPT undergoing maintenance hemodialysis from April 2021 to February 2023 were selected as the re-search subjects.The ultrasonographic characteristics of patients with SHPT of different degrees were compared,the diagnostic efficiency of ultrasound in patients with SHPT was analyzed,and the related influencing factors of ultrasound misdiagnosis were analyzed by multivariate Logistic regression.Then,according to whether the parathyroid hyperplasia was detected,they were divided into hyperplasia group(n=127)and control group(n=63).Multivariate Logistic regression model was established to analyze the independent risk factors of parathyroid hyperplasia in SHPT patients,and the diagnostic efficacy of different methods for parathyroid hyperplasia was analyzed.Results With the increase of the severity of SHPT,the proportion of mul-tiple hyperplasia,low echo,irregular nodules,rich blood supply,uneven internal echo and calcification also increased.The sensitivity,specificity,misdiagnosis rate and missed diagnosis rate of ultrasonography were 0.881,0.657,34.29%and 11.86%,respectively.Nodule maximum diameter,nodule morphology and nodule blood supply were all influencing factors for ultrasound misdiagnosis of parathyroid hyperplasia in SHPT patients(P＜0.05).Duration of dialysis,alkaline phospha-tase,blood phosphorus and parathyroid hormone levels were independent risk factors for parathyroid hyperplasia in SHPT pa-tients(P＜0.01).The area under the receiver working characteristic(ROC)curve(AUC)of ultrasonography,Logistic re-gression model alone and in combination in the diagnosis of parathyroid hyperplasia were 0.773,0.754 and 0.889,respec-tively,among which the combined diagnosis was the highest,and the accuracy(0.840)and Jorden index(0.679)were higher than other methods.Conclusion With increased severity of SHPT in patients undergoing maintenance hemodialysis,the morphological and structural changes of parathyroid glands became more significant,and the misdiagnosis rate of parathy-roid hyperplasia by ultrasound was higher.Nodule morphology,nodule maximum diameter and nodule blood supply had a sig-nificant impact on the diagnostic results of ultrasound.Ultrasound combined with Logistic regression model is of high value in the diagnosis of parathyroid hyperplasia in patients with SHPT.