| Objective: To investigate the value of conventional ultrasound,quantified tissue imaging(VTIQ)by acoustic palpation and contrast ultrasound(CEUS)parameters of parathyroid glands and clinical indexes in evaluating the severity of secondary hyperparathyroidism(SHPT).Methods: 76 patients with chronic kidney disease and SHPT,who received hemodialysis treatment in Hemodialysis Center of the First Affiliated Hospital of Shihezi University from October 2020 to December2022 were incorporated and grouped into mild group(i PTH300～800pg/m L)and severe group(i PTH ≥ 800pg/ m L)according to the level of i PTH.All patients were examined by routine ultrasound and VTIQ,and 21 patients were examined by CEUS.The differences of routine ultrasound features(position,number,shape,size,blood supply,etc.),VTIQ parameters(SWVmax,SWVmin,SWVmean,SWVratio)and clinical indexes(dialysis age,Ca,P,ALP,serum albumin and SCr)between the two groups were analyzed and compared.Statistically significant variables screened out of the two groups and included in the regression equation,in addition to evaluate the value of the model in predicting the severity of SHPT.Meanwhile,the relationship between the characteristics and quantitative parameters of CEUS(AT,TTP,MTT,AMP,PI,etc.)and i PTH in patients with SHPT was analyzed and studied.Results:(1)The differences in dialysis age,P,ALP,corrected Ca × P,average parathyroid lesion volume,blood supply score,average SWVmax and average SWVmean were statistically significant between mild SHPT group and severe SHPT group,(all P < 0.05).(2)Blood supply score(OR:2.441;95%CI:1.162～5.130),average SWVmean(OR:0.007;95% CI:0.000～0.639),dialysis age(OR:1.182;95% CI:1.046～1.335),P(OR:0.204;95% CI:1.313～10.260)and corrected Ca× P(OR:5.483;95% CI:1.306～23.061)were significantly different between mild SHPT group and severe SHPT group as shown in both univariate and multivariate regression analysis,Therefore,they were independent factors affecting the level of i PTH in patients with SHPT.(3)The regression equation was established: Logit(P)=-34.885 + 0.893 × blood supply score-4.962× average SWVmean + 0.167 × dialysis age + 8.686 × P+1.702 × corrected Ca × P.The area under the curve AUC(95%CI),sensitivity,specificity and accuracy for predicting the severity of SHPT were 0.964(0.895～0.993),85.37%,97.14% and 90.79%,respectively,and the positive predictive value were 85.00%,the negative predictive value and 97.22% when the cutoff value was-5.97.The AUC(95%CI)of blood supply score,average SWVmean,dialysis age,P and correcting Ca × P to predict the severity of SHPT were0.826(0.722 0.904),0.565(0.446 0.79),0.851(0.751 0.922),0.773(0.662 0.61),0.824(0.719 0.902),respectively.The effectiveness of the model in predicting the severity of SHPT was significantly higher than that of each single factor(Z= 3.149,5.967,3.073,3.726,3.084,all P < 0.05).The prediction results of the model were in good agreement with the clinical diagnosis(Kappa=0.817,P=0.000).(4)There were significant differences in CEUS features of parathyroid gland with different i PTH levels(early enhancement mode,late enhancement mode,enhancement direction and contrast medium regression);The parathyroid lesions were mainly enhanced by diffuse enhancement in the early and late enhancement stage of CEUS,and disappeared synchronously with the surrounding thyroid tissue.(5)The quantitative parameters PI and AMP of CEUS in parathyroid lesions were positively correlated with the level of i PTH(r = 0.686,0.757,all P <0.05),and the level of TTP was negatively correlated with the level of i PTH(r =-0.420,P = 0.004).AMP was most significantly correlated with i PTH,followed by TTP,and the standardized regression coefficients were 0.647 and-0.243,all P < 0.05.Conclusion: Ultrasonic characteristics and clinical indicators can predict the severity of Secondary hyperparathyroidism.The combined prediction model has great value in evaluating the progression of Secondary hyperparathyroidism. |
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