Doç Dr Garip ŞAHİN Eskişehir Osmangazi Üniversitesi · mİbİ duyarliliĞi fonksİyonel paratİroİd dokusunun bÜyÜklÜĞÜİle orantilidir

Doccedil Dr Garip ŞAHİN

Eskişehir Osmangazi Uumlniversitesi

Tıp Fakuumlltesi Nefroloji Bilim Dalı

31 MART 2017 NEFROLOJİ KIŞ OKULU

CcedilEŞME-İZMİR

Azalmış GFR

125(OH)2D3

azalmış

Vit Drezistan

durum

Artmış vit D

ihtiyacı

VDR ekspres

yonunda azalma

Sekonder

HPTH

Hipokalsemi

Kısmi - tam

125(OH)2D3

eksikliği

Azalmış

intestinal ca

PTH

İskelet direnci

Normal - duumlşuumlk

125(OH)2DBoumlbreklerde

125(OH)2D

produksionunda

azalma

Fosfat

retansiyonu

Paratiroidde CaSR

ekspresyonunda

azalma

Kemik rezorpsiyon

Osteitis fibroza sistika

Rikets-

osteomalaziAJKD 424200334

HİPERPARATİROİDİZM PATOGENEZİ


Reproduced with permission from Qunibi W Pathogenesis of Secondary Hyperparathyroidism in CKD

In Principles and Practice of Dialysis 4th ed Lippincott Williams amp Wilkins Philadelphia 2009


Perm J 2016 Summer 20(3) 78ndash83


KBH GFR PTH CaP PTH

Evre mLdk173m2 (Hedef)

3 30-59 Bazal 6-12ay N

4 15-29 6-12ay 3-6ay N

5 lt15 ndashDiyaliz 3-6ay 1-3ay 2-9 N

KBHrsquoda PTH ve CaP DEĞERLENDİRMESİ


Sekonder hiperparatiroidi olan SDBYrsquolikli

hastalarda paratiroidektomi oranı 10 rsquodur

HD suumlresi 10-15 yıl 92

16-20 yıl 208gt20 yıl 40

Geccediltiğimiz 20 yılda medikal tedavilerin gelişmesine rağmen bu oran hala devam

etmektedir

PARATİROİDEKTOMİ PREVALANSI

Foley RN JASN 200526210

Timeline of various treatments for mineral and bone disorders in chronic

kidney disease (CKD-MBD)

Csaba P Kovesdy et al CJASN 20083168-173

Rekuumlrren laringeal sinirin inferior

faringeal konstriktoumlr kas altından

geccedilip larenkse girdiği noktada

Genellikle tiroidin alt kutbu

yakınındadırlar

PARATİROİD BEZİ ANATOMİSİ

Medikal tedavi PTH

Gecikmiş yada yetersiz tedavi

Persistan hiperfosfatemiParatiroid bez kitlesinde

artış

Poliklonalparatiroid huumlcre proliferasyonu

Adenomatoumlzdokunun

monoklonalexpansiyonuHipokalsemi

Kalsitriol eksikliğiHiperfosfatemi

NEDENLERİ

TEKRARLAYAN HİPERPARATİROİDİZM PATOGENEZİ

Krause MW Hum Pathol 198516772

Poliklonalparatiroid

huumlcre proliferasyonu


monoklonalexpansiyonu

PARATİROİD BEZ

KİTLESİNDE ARTIŞ

HipokalsemiKalsitrioleksikliğİ

Hiperfosfatemi

CaSR expresyonuVDR danstesinde

SERUM CAKALSİTRİOL

situmilusuna yanıt yoktur


Gogusev J Kidney Int 199751328

Shunsuke Goto NDT Plus 2008 Aug 1(Suppl 3) iii2ndashiii8


EN AZ 1 TANE PARATİRİD BEZİ

gt05 cm3500 mgrgt1 cm ccedilap

Langenbecks Arch Surg (2015) 400887ndash905

PARATİROİDEKTOMİ ENDİKASYONLARI

ŞİDDETLİ PTH YUumlKSEKLİĞİ (gt800 pgmL)

PTH gt800

MEDİKAL TEDAVİYE RAĞMEN PTH YUumlKSEKLİĞİ

MEDİKAL TEDAVİYERAĞMEN PTH YUumlKSEKLİĞİ

SEMPTOMATİK OLMASI ASEMPTOMATİK OLMASI

PARATİROİDEKTOMİ TARTIŞMALIDIRYAPILABİLİR

HİPERKALSEMİHİPERFOSFATEMİKEMİK HASTALIĞI

TEKRARLAYAN KAŞINTIİSKELET DIŞI KALSİFİKASYON

KALSİFLAKŞİACcedilIKLANAMAYAN MİYOPATİ

PARATİROİDEKTOMİ

wwwuptodatecom 2017Perm J 2016 Summer 20(3) 78ndash83

SYMPTOMS OF HYPERPARATHYROIDISM

1 Neurologic manifestations

Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma

2 Gastrointestinal manifestations

Constipation

Nausea and vomiting

Pancreatitis

Peptic ulcer disease

3 Renal manifestations

Uremia

Nephrolithiasis

4 Cardiovascular manifestations

Hypertension

Arrhythmias

Coronary artery disease

Shortened QT interval

5 Bone manifestations

Bone pain

FracturesAdv Surg 2011 45 237ndash248

Calciphylaxis

Calciphylaxis


VASKUumlLER KALSİFİKASYON


ASEMPTOMATİK HASTALAR

GENCcedil VAKALAR lt65 YAŞ

KOMORBİD DURUMLARIN AZ OLDUĞU KİŞİLER

CERRAHİYİ TOLERE EDEBİLECEK HASTALAR

ASEMPTOMATİK VAKALARDA PARATİROİDEKTOMİ İCcedilİN ŞART OLAN PTH DUumlZEYİ TAM BİLİNMEMEKTEDİR

(PTHgt1000 pgmL)

KDIGO KLAVUZLARINDA PARATİROİDEKTOMİ İCcedilİN GEREKLİ PTH DEĞERLERİ NET DEĞİLDİR

Core curriculum Am J Kidney Dis 2011581022 httpkdigoorghomemineral-bone-disorder2014

TEKRARLAYAN HİPERPARATİROİDİZMİN TEDAVİSİ

ENJEKSİYON TEDAVİSİETANOL ENJEKSİYONUKALSİTRİOL

CERRAHİ PARATİROİDEKTOMİSUBTOTAL (20) TOTAL VE OTOTRANSPLANTASYONU (68) TOTAL PARATİROİDEKTOMİ (10)

TOTAL VE OTOTRANSPLANTASYONU

TEKRARLAYAN HİPERPARATİROİDİZMİN TEDAVİSİTOTAL PARATİROİDEKTOMİ SUBTOTAL

Parathyroid intervention

Masafumi Fukagawa et al Nephrol Dial Transplant

200318iii31-iii33


(B) parathyroid adenomas identified by ultrasound

Am J Otolaryngol 2012 Jul 33(4) 457ndash468

PREOPERATİF DEĞERLENDİRİLMESİ

(A) behind the left lower pole

Hypoechoic left lower pole

Image after administration of sestamibi (2-h) delay demonstrates left inferior parathyroid adenoma Am J Otolaryngol 2012 Jul 33(4) 457ndash468


SPECTCT demonstrating a right side parathyroid adenoma



Computed tomography demonstrating a left sided parathyroid adenoma



MRI demonstrating a left parathyroid adenoma



PRE-OPERATIVE STUDIES IN RE-OPERATIVE PARATHYROIDECTOMY

Non-Invasive Techniques

Ultrasonography

Sestamibi scintigraphy

Computed tomography scan

Magnetic resonance imaging

Positron emission tomography scanning

Invasive Techniques

Fine-needle aspiration

Arteriography

Venous samplingAdv Surg 2011 45 237ndash248

Intraoperative NIR( Near-infrared) fluorescence-guided resection of a parathyroidadenoma located in the neck

During minimally-invasive parathyroid surgery a 19 mm parathyroid adenoma is identified using NIR fluorescence imaging (arrow)

Surgery 2015 Nov 158(5) 1323ndash1330 Published online 2015 May 6 doi 101016jsurg201503027

İNTRAOPERATİF DEĞERLENDİRİLMESİ



Intraoperative NIR fluorescence imaging of normal parathyroid glands A 2 mm normal parathyroid gland (arrow) was identified in the right thymus using NIR fluorescence imaging after thymectomy B A 1 mm normal parathyroid gland (arrow) was identified in the left thymus using NIR fluorescence imaging after thymectomy Both glands in A and B could not be identified using visual inspection

B During minimally-invasive parathyroid surgery a parathyroid adenoma is identifiedusing NIR fluorescence imaging 5 and 10 minutes postinjection of 05 mgkg MB T= thyroid tissue

A 3D SPECT-CT image 2 h postinjection of 99mTc-sestamibi with visualization of a parathyroid adenoma located at theright side of the neck (arrow)


A 3D SPECT-CT image 2 h postinjection of 99mTc-sestamibi with visualization of a parathyroid adenoma located paratracheally in the mediastinum (arrow)

Head Neck 2014 Jun 36(6) 853ndash858

B A parathyroid adenoma located paratracheally in the mediastinum is identifiedusing NIR fluorescence imaging 10 minutes postinjection of 05 mgkg MB


Schematic overview of parathyroid adenoma location and corresponding detection methods


Shown is the location of all parathyroid adenomas (N = 10) and one parathyroid carcinoma (N = 1 Asterix) and corresponding imaging modalities with which they were identified The patient with parathyromatosis was excluded from this scheme


Transverse ultrasound of the neck shows a right inferior parathyroid adenoma Thelesion demonstrates a hypoechoic well defined oval shaped homogenous shape which is characteristic of a parathyroid adenoma T thyroid CA carotid artery PA parathyroid adenoma Gland Surg 2015 Oct 4(5) 420ndash428


Landmarks for the robotic trans-axillary incisions

Gland Surg 2015 Oct 4(5) 420ndash428

Ref CentreTotal number of patients

Failure rateCause of failure

Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]

Universityof Sydney Australia

1020 23 (22 )10 DA 3 MGD

İNVAZİF PARATİROİDEKTOMİ YETERSİZLİĞİNİN SEBEBİ OLARAK

MULTİGLANDULAR HASTALIK

MGD multiglandular disease DA double adenoma


Prelesion test characteristics for all patients

MGD lesions SGD lesions All lesion

Sensitivity 61 (201331) 97 (503520) 83 (704851)

Specificity 84 (163193)93

(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)

Positive predictive value

87 (201231) 82 (505613) 83 (704844)

Negativepredictive value

56 (163293)99

(14501467)92

(16131760)

Modified form refs [73 74]

MGD multiglandular disease SGD single gland disease

pthinspltthinsp005 MGD vs SGD

Scintigraphy is significantly less sensitive and less specific for

detecting MGD than singular gland disease


Effect of increasing lesion number per patient on test performance

1 lesion 2 lesions 3 lesions 4 lesions

Sensitivity 97 (503520)68

(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)

Negative predictive value

99 (14501467)

72 (124172)

41 (3995) 0 (026)

The sensitivity of the test decreases progressively as the number

of the lesion increases


pthinspltthinsp005 vs one lesionLangenbecks Arch Surg (2015) 400887ndash905

MİBİ DUYARLILIĞI FONKSİYONEL PARATİROİD DOKUSUNUN BUumlYUumlKLUumlĞUuml İLE ORANTILIDIR

lt03 GR İSE GOumlRUumlNTUumlLENEMEZ

03-05 GR NADİREN GOumlRUumlNTUumlLENEBİLİR

05-15 GR 70-80 SENSİTİF

gt15 GR 90 SENSİTİF

HİPERPLAZİDE SENSİTİVİTE 30-70 ADENOMDA 90

MİBİ+ YUumlKSEK CcedilOumlZUumlNUumlRLUumlKLUuml USG DUYARLILIĞI 95

SPECT REOPERASYON PLANLANAN HASTALARDA EKTOPİK DOKU İCcedilİN GEREKLİDİR

COHORT CcedilALIŞMADA4558 PARATİROİDEKTOMİ YAPILAN HASTA 4558 CERRAHİ YAPILMAYAN KONTROL

KISA DOumlNEMDE(30 GUumlN)MORTALİTE 3112 OLACAK ŞEKİLDEPARATİROİDEKTOMİ GRUBUNDA DAHA FAZLADIR

UZUN DOumlNEMDE YAŞAM ORANLARINA BAKILDIĞI ZAMAN 5347 OLACAK ŞEKİLDE CERRAHİ YAPILAN GRUPTA DAHA İYİ BULUNMUŞTUR

KARDİYOVASKUumlLER HASTALIKLARDA AZALMAİYİ KAN BASINCI KOTROLUuml

HİPERPARATİROİDİ TEDAVİLERİNİN AZALMASIHİPERFOSFATEMİNİN AZALMASI

UZUN DOumlNEMDE YAŞAM SUumlRESİNİN ARTMASI

Kidney Int 2004 Nov66(5)2010-6 Survival following parathyroidectomy among United States dialysis patients

PARATİROİDEKTOMİNİN RİSK VE SONUCcedilLARI


CERRAHİ SONRASI KLİNİK SONUCcedilLARI DİREK OLARAK KARŞILAŞTIRAN RANDOMİZE KONTROLLUuml CcedilALIŞMA LAR YOKTUR

1 YILLIK MORBİDİTE VE MORTALİTE ORANI USRDSrsquoDEN VERİLERİN ANALİZİNDEN RAPORLANMIŞTIR

MEDICAL EVIDENCE REPORT

UNOSMEDICARE

CLAİMS

4435 HASTA SECcedilİLMİŞTİR

DIŞLAMA KRİTERLERİHD OLAN HASTALAR

PARATİROİDEKTOMİ OumlNCESİ 1 YIDAN AZ MEDİKAL TEDAVİ GOumlRENLERlt19 YAŞ

MEDİKAL RAPOR KANITLARI OLMAYANLAR

(Kidney Int 2004662010 Clin J Am Soc Nephrol 20151090)

VERİLERİN ANALİZ SONUCcedilLARI

MORTALİTE HASTANE YATIŞI SIRASINDA 2 DİR

CERRAHİYİ İZLEYEN 30 GUumlN İCcedilİNDE TABURCU EDİLMİŞTİR

25 HASTA HASTANE YATIŞLARI SIRASINDA YBUumlrsquoE İHTİYACcedil DUYULMUŞTUR

24 HASTA TABURCU OLDUKTAN SONRA 30 GUumlN İCcedilERİSİNDE TEKRAR HASTANE YATIŞ İHTİYACcedilLARI

OLMAKTADIRBUNLARIN 29rsquoU YBUumlrsquoE BAŞVURMASI GEREKLİ

OLMUŞTUR(Kidney Int 2004662010 Clin J Am Soc Nephrol 20151090)

VERİLERİN ANALİZ SONUCcedilLARIPARATİROİDEKTOMİ OumlNCESİ 1 YIL İLE KARŞILAŞTIRILIRSA

İNME MI RİTİM BOZUKLUĞUNDAN HASTANE YATIŞLARININ İNSİDANSI YUumlKSEKTİR

HİPOKALSEMİ İCcedilİN HASTANE YATIŞLARI CcedilOK DAHA YUumlKSEKTİR

HASTANE YATIŞ GUumlNLERİNİN TOTAL SAYISI YUumlKSEKTİR

YOĞUN BAKIM UumlNİTESİ BAŞVURUSU YUumlKSEKTİR


TRANSPLANTASYON BEKLEYEN HASTALAR

POTANSİYEL TRANSPLANT ALICILARI İCcedilİN YAKLAŞIM MERKEZLER ARASI FARKLILIK GOumlSTERİR

TRANSPLANTASYON YAKIN DEĞİLSE ENDİKASYON VARSA PARATİROİDEKTOMİ OumlNERİLİR

TRANSPLANTASYON SONRASI HİPERPARATİROİDİZM GERİLER

TRANSPLANTASYON OumlNCESİ ŞİDDETLİ HİPERPARATİRODİZM OLANLARDA TX SONRASI PTH VE CA YUumlKSEK SEYREDER BU DA AZALMIŞ GRAFT FONKSİYONU İLE İLİŞKİLİDİR

PARATİROİDEKTOMİ TX OumlNCESİ YAPILIRSA DAHA GUumlVENLİ OLABİLİR

Clinics 201166431Clin Ttansplant 201226393Clin Nephrol 199747248

ALİMİNYUM İLİŞKİLİ KEMİK HASTALIĞI ACcedilISINDAN DEĞERLENDİRİLMELİ

PARATİROİDEKTOMİ OumlNCESİ ALİMİNYUM TOKSİSİTESİ VARSA TEDAVİ EDİLMELİDİR

ALİMİNYUM İLİŞKİLİ OLMAYAN APLASTİKADİNAMİK KEMİK HASTALIĞI DIŞLANMALIDIR

KEMİK HASTALIĞI AĞIRLAŞABİLİR

CERRAHİ DEĞERLENDİRME

Kidney Int 199344860

PARATİROİDEKTOMİNİN POTANSİYEL FAYDALARI

HİPERKALSEMİ HİPERFOSFATEMİDE DUumlZELME

KEMİK AĞRILARINDA AZALMA

MİYOPATİDE DUumlZELME

KALSİFLAKSİDE GERİLEME

VASKUumlLER VE VALVUumlLER KALSİFİKASYONDA GERİLEME

EPO REZİSTAN ANEMİYİ DUumlZELTEBİLİR

BİLİŞSEL FONKSİYONLARDA ARTIŞ

KAŞINTININ AZALMASI

KEMİK DANSTESİNİ VE FRAKTUumlR RİSKİNİ AZALTABİLİR

BESLENME DURUMU HUMORAL VE HUumlCRESEL İMMUNİTEYİ İYİLEŞTİREBİLİR

MORTALİTEDE AZALMAJ Am Soc Nephrol 2007182401Arch Surg 200814397

Azalmış GFR

125(OH)2D3

azalmış

Vit Drezistan

durum

Artmış vit D

ihtiyacı

VDR ekspres

yonunda azalma

Sekonder

HPTH

Hipokalsemi

Kısmi - tam

125(OH)2D3

eksikliği

Azalmış

intestinal ca

PTH

İskelet direnci

Normal - duumlşuumlk

125(OH)2DBoumlbreklerde

125(OH)2D

produksionunda

azalma

Fosfat

retansiyonu

Paratiroidde CaSR

ekspresyonunda

azalma

Kemik rezorpsiyon

Osteitis fibroza sistika

Rikets-

osteomalaziAJKD 424200334








KBH GFR PTH CaP PTH


3 30-59 Bazal 6-12ay N

4 15-29 6-12ay 3-6ay N







16-20 yıl 208gt20 yıl 40


etmektedir










yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS


















































KBH GFR PTH CaP PTH


3 30-59 Bazal 6-12ay N

4 15-29 6-12ay 3-6ay N







16-20 yıl 208gt20 yıl 40


etmektedir










yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS

















































KBH GFR PTH CaP PTH


3 30-59 Bazal 6-12ay N

4 15-29 6-12ay 3-6ay N







16-20 yıl 208gt20 yıl 40


etmektedir










yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































KBH GFR PTH CaP PTH


3 30-59 Bazal 6-12ay N

4 15-29 6-12ay 3-6ay N







16-20 yıl 208gt20 yıl 40


etmektedir










yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS












































KBH GFR PTH CaP PTH


3 30-59 Bazal 6-12ay N

4 15-29 6-12ay 3-6ay N







16-20 yıl 208gt20 yıl 40


etmektedir










yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS















































16-20 yıl 208gt20 yıl 40


etmektedir










yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS



















































yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS
















































yakınındadırlar


Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS












































Medikal tedavi PTH



artış





NEDENLERİ







PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS
















































PARATİROİD BEZ

KİTLESİNDE ARTIŞ


Hiperfosfatemi













PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS



















































PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS

















































PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































PTH gt800








PARATİROİDEKTOMİ




Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































Depression

Muscle weakness

Fatigue

Memory loss

Ataxia

Coma


Constipation

Nausea and vomiting

Pancreatitis



Uremia

Nephrolithiasis


Hypertension

Arrhythmias




Bone pain


Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS












































Calciphylaxis

Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS












































Calciphylaxis









(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS




















































(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS



















































(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS


















































(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS

















































(PTHgt1000 pgmL)










200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS



















































200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS
















































200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































200318iii31-iii33




















Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS






























































Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS

























































Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS























































Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS




















































Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS

















































Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































Ultrasonography





Invasive Techniques


Arteriography


























Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS




































































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS
































































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS





























































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS


























































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS






















































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS


















































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS
















































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































Lee et al [19]

MD Anderson USA

357 19 (35 ) 9 MGD

Bagul et al [20]

Sheffield UK

541 25 (5 )13 MGD (25 )

Suliburk et al [21]


1020 23 (22 )10 DA 3 MGD







Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS














































Sensitivity 61 (201331) 97 (503520) 83 (704851)


(14501560)92

(16131753)

Accuracy 69 (364524)94

(19532080)89

(23172604)


87 (201231) 82 (505613) 83 (704844)


56 (163293)99

(14501467)92

(16131760)










(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS















































(100148)59 (79135) 46 (2248)

Specificity93

(14501560)84

(124148)87 (3945)

Accuracy94

(19532080)76

(224296)66

(118180)46 (2248)


82 (505613) 81 (100124) 93 (7985) 100 (2222)


99 (14501467)

72 (124172)

41 (3995) 0 (026)

























UNOSMEDICARE

CLAİMS
































































UNOSMEDICARE

CLAİMS
























































UNOSMEDICARE

CLAİMS
















































UNOSMEDICARE

CLAİMS








































































































































































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Doç Dr Garip ŞAHİN Eskişehir Osmangazi Üniversitesi · mİbİ duyarliliĞi fonksİyonel paratİroİd dokusunun bÜyÜklÜĞÜİle orantilidir