Superb microvascular imaging for evaluating the efficacy of microwave ablation in primary Hyperparathyroidism: A prospective study.

OBJECTIVES

To evaluate the utility of superb microvascular imaging (SMI) for assessing ablation completeness and predicting clinical outcomes after microwave ablation (MWA) in patients with primary hyperparathyroidism (PHPT).

METHODS

This prospective study included 57 patients (10 men, 47 women; mean age, 58.0 ± 11.3 years) who underwent MWA for PHPT between September 2023 and January 2025. SMI examinations were performed before and 1 month after ablation. Complete ablation was defined as the absence of intranodular vascularity on follow-up SMI. Clinical success was defined as maintenance of normocalcemia during the 6-month follow-up.

RESULTS

The clinical success rate was 73.7 %. At 1 month, SMI identified incomplete ablation in 12 of 57 nodules. Clinical success was achieved in 1 of 12 incompletely ablated nodules (8.3 %) compared with 41 of 45 completely ablated nodules (91.1 %). Incomplete ablation was independently associated with reduced odds of clinical success (OR 0.016; 95 % CI 0.001-0.092; p < 0.001). For predicting clinical outcome, SMI-defined ablation completeness yielded a sensitivity of 73.3 %, specificity of 97.6 %, positive predictive value of 91.7 %, and negative predictive value of 91.1 %.

CONCLUSION

SMI showed promising performance in assessing ablation completeness and predicting clinical outcomes after MWA for PHPT. Early detection of incomplete ablation on follow-up SMI may help identify patients at risk for clinical failure and support decisions regarding additional treatment.