Preoperative Localization Strategies in Primary Hyperparathyroidism

"Ultrasound contrast agent: Stabilized sulfur hexafluoride microbubbles (SonoVue®, Bracco).~An 18 G needle will be placed in an antecubital vein and directly attached to a three-way stopcock with an extension tube.~The SonoVue® will be prepared and shaken shortly before injection in accordance with the instructions provided in the product information leaflet.~The patient will be injected with 1.2 ml SonoVue® at a pace of 1-2 ml/s using the 180 degree straight-flow channel of the three-way stopcock, directly followed by a 10 ml bolus of sodium chloride 9 mg/mL (0.9%) injected into the 90 degree channel of the three-way stopcock at a pace of approximately 2 ml/s.~A full examination will typically require one to two injections of 1.2 ml of SonoVue® (one injection per suspected parathyroid adenoma)."