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DOI: 10.1055/a-2731-9908
Preoperative ultrasound detection of arteria lusoria and non-recurrent laryngeal nerve anatomical variation: a retrospective study
US Detection of Arteria Lusoria in Cervicotomy Sonographische Erkennung der Arteria lusoria bei Zervikotomie.Authors
Abstract
Purpose
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.
Materials and Methods
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.
Results
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%.
Conclusion
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.
Zusammenfassung
Ziel
Die Arteria lusoria (AL), eine seltene Gefäßvariante (Prävalenz 0,5–3,2%), ist mit einem nicht rezidivierenden rechten Nervus laryngeus (RNRLN) assoziiert und erhöht somit das Risiko einer Nervenverletzung während einer Schilddrüsen- und Nebenschilddrüsen-Chirurgie. Diese Studie untersucht den Stellenwert der Ultraschalluntersuchung (US) zur präoperativen Detektion der AL.
Material und Methode
Retrospektive Analyse von 1406 Patienten mit Hyperparathyreoidismus, die sich einer 18F-Fluorcholin-PET/CT unterzogen. Subgruppen-Analyse bei 270 Patienten mit vor Ort durchgeführtem „Experten-US“. Ein erfahrener Oberarzt für Radiologie beurteilte das US-Y-Bild (Teilung des Truncus brachiocephalicus), wobei eine Niedrigdosis-CT als Referenzstandard zur Bestätigung der AL diente.
Ergebnisse
Die 18F-Fluorcholin-PET/CT-Analyse identifizierte 22 AL (Prävalenz: 1,57%). Im Ultraschall wurden 259 Y-Bilder ohne Nachweis einer AL gefunden, bestätigt durch CT. Fünf fehlende Y-Bilder wiesen auf eine AL hin, die alle durch CT bestätigt wurden. Sechs nicht beurteilbare Y-Bilder waren in der CT AL-negativ. Die US-Leistung: Sensitivität 100% (95%-KI: 0,463–1), Spezifität 98% (95%-KI: 0,95–0,99), negativer prädiktiver Wert (NPV) 100%, Genauigkeit 98%.
Schlussfolgerung
Die Beurteilung des US-Y-Bildes schließt das Vorliegen einer AL zuverlässig mit einem NPV von 100% aus – und stellt somit ein nicht invasives Verfahren dar, um das Risiko einer RNRLN-Verletzung während einer Schilddrüsen- und Nebenschilddrüsen-Chirurgie zu reduzieren.
Keywords
right non-recurrent laryngeal nerve - cervical ultrasonography - cervical surgery - laryngeal paralysis - arteria lusoriaPublication History
Received: 28 June 2025
Accepted after revision: 24 October 2025
Accepted Manuscript online:
24 October 2025
Article published online:
16 January 2026
© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
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