Preoperative ultrasound detection of arteria lusoria and non-recurrent laryngeal nerve anatomical variation: a retrospective study.

Arteria lusoria (AL), a rare vascular variant (prevalence of 0.5-3.2%), is linked to a right non-recurrent laryngeal nerve (RNRLN), thereby increasing nerve injury risk during thyroid and parathyroid surgery. This study evaluates ultrasonography (US) for preoperative AL detection.Retrospective analysis of 1406 hyperparathyroidism patients undergoing 18F-fluorocholine PET/CT with subgroup analysis in 270 patients with "expert US" performed on-site. An experienced senior radiologist assessed the US Y-image (brachiocephalic artery division), with low-dose CT as the standard of truth for AL confirmation.18F-fluorocholine PET/CT analysis found 22 cases of AL (prevalence: 1.57%). US identified 259 Y-images, excluding AL, confirmed by CT. Five absent Y-images indicated AL, all were confirmed by CT. Six non-assessable Y-images were AL-negative on CT. US performance: sensitivity 100% (95% CI: 0.463-1), specificity 98% (95% CI: 0.95-0.99), negative predictive value (NPV) 100%, accuracy 98%.US Y-image assessment reliably excludes AL with an NPV of 100%, offering a non-invasive tool to reduce RNRLN injury risk in thyroid and parathyroid surgery.