18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients

Abstract

PurposeIn this prospective study we compared the accuracy of 18F-fluorocholine PET/CT with that of 99mTc-MIBI or99mTc-tetrofosmin SPECT/CT in the preoperative detection of parathyroid adenoma in patients with primary hyperparathyroidism. We also assessed the value of semiquantitative parameters in differentiating between parathyroid hyperplasia and adenoma.MethodsBoth 18F-fluorocholine PET/CT and 99mTc-MIBI/tetrofosmin SPECT/CT were performed in 100 consecutive patients with biochemical evidence of primary hyperparathyroidism. At least one abnormal focus on either 18F-fluorocholine or 99mTc-MIBI/tetrofosmin corresponding to a parathyroid gland or ectopic parathyroid tissue was considered as a positive finding. In 76 patients with positive findings on at least one imaging modality, surgical exploration was performed within 6 months, and the results were related to histopathological findings and clinical and laboratory findings at 3–6 months as the standard of truth. In 24 patients, no surgery was performed: in 18 patients with positive imaging findings surgery was refused or considered risky, and in 6 patients imaging was negative. Therefore, data from 82 patients (76 undergoing surgery, 6 without surgery) in whom the standard of truth criteria were met, were used in the final analysis.ResultsAll patients showed biochemical evidence of primary hyperparathyroidism with a mean serum calcium level of 2.78 ± 0.34 mmol/l and parathormone (PTH) level of 196.5 ± 236.4 pg/ml. The study results in 76 patients with verified histopathology and 3 patients with negative imaging findings were analysed. Three of six patients with negative imaging showed normalized serum PTH and calcium levels on laboratory follow-up at 3 and 6 months, and the results were considered true negative. In a patient-based analysis, the detection rate with 18F-fluorocholine PET/CT was 93% (76/82), but was only 61% (50/82) with 99mTc-MIBI/tetrofosmin SPECT/CT. In a lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of 18F-fluorocholine PET/CT in the detection of parathyroid adenoma were 93.7%, 96.0%, 90.2%, 97.4% and 95.3%, respectively, and of 99mTc-MIBI/tetrofosmin SPECT/CT were 60.8%, 98.5%, 94.1%, 86.3% and 87.7%, respectively. Although 18F-fluorocholine PET-positive adenomatous lesions showed higher SUVmax values than the hyperplastic glands (6.80 ± 3.78 vs. 4.53 ± 0.40) in the semiquantitative analysis, the difference was not significant (p = 0.236). The mean size (measured as the length of the greatest dimension) and weight of adenomas were 15.9 ± 7.6 mm (median 15 mm, range 1–40 mm) and 1.71 ± 1.86 g (median 1 g, range: 0.25–9 g), respectively. Among the analysed parameters including serum calcium and PTH and the size and weight of parathyroid adenomas, size was significantly different between patients with negative 99mTc-MIBI/tetrofosmin SPECT/CT and those with positive 99mTc-MIBI/tetrofosmin SPECT/CT (mean size 13.4 ± 7.6 mm vs. 16.9 ± 7.4 mm, respectively; p = 0.042)....

The role of 18F-FCH PET/CT in patients with uremic hyperparathyroidism compared with 99mTc-sestaMIBI SPECT/CT and ultrasonography

“…As presented in Table 3, volumes of the hyperfunctioning parathyroid glands were significantly different between lesions positive in 18 F-FCH PET/CT and negative in 18 F-FCH PET/CT. Lesions positive in 18 F-FCH PET/CT and positive in 99m Tc-sestaMIBI SPECT/CT were larger than lesions positive in 18 F-FCH PET/CT and negative in 99m Tc-sestaMIBI SPECT/CT, but the difference was not significant. In all, 3 of 63 lesions were located in the right lobe of the thyroid gland.…”

“…The number of lesions localized by the 3 methods at different locations is shown in Additional file 1: Table S2. Diagnostic efficacy and superiority of 18…”

“…Of the 63 parathyroid lesions removed by surgery, 18 F-FCH PET/CT correctly localized 53 lesions with no false-positive results. All lesions were visible in PET/CT images at both imaging times.…”

“…However, no conventional imaging method shows great superiority at present. 18 F-fluorocholine (FCH) PET, a common imaging modality used for prostate cancer, can be used to localize hyper-functioning parathyroid glands [11], and many studies have indicated that it has high diagnostic efficiency for primary hyperparathyroidism (PHPT) [9,[12][13][14]; nevertheless, no clinical study has only evaluated the diagnostic value of 18 F -FCH PET for uHPT. In this study, the diagnostic performance of preoperative gland localization of 18 F -FCH PET/CT for uHPT was investigated compared to 99m Tc-sestaMIBI SPECT/CT and US.…”

Primary Hyperparathyroidism Manifesting with Severe Hypercalcemia in a Nonagenarian Man: Pitfall of Common Imaging Techniques, Localization by 18F-Choline Positron Emission Tomography/Computed Tomography and Successful Management with Calcimimetics

“…Finally, a few patients have potentially life-threatening hypercalcemia (3). Neck ultrasonography (USG) and 99m Technetium-sestamibi (SESTAMIBI) scintigraphy are the most frequently used morphological and functional imaging techniques to detect pathological parathyroid glands; however, 18 F-choline Positron Emission Tomography (PET)/Computed Tomography (CT) is being increasingly used in difficult/equivocal cases (4). Although parathyroidectomy remains the only definitive cure for PHPT, surgery is rarely advocated in elderly adults, because of concerns about comorbidities (1); in addition, calcimimetics have opened up a new therapeutic era.…”