Diagnostic utility of ¹¹C‐methionine PET/CT in primary hyperparathyroidism in a UK cohort: A single‐centre experience and literature review

Abstract

Objective: Primary hyperparathyroidism is a common endocrine disorder, with 80% of all cases usually caused by one single hyperfunctioning parathyroid adenoma.Conventional imaging modalities for the diagnostic work-up of primary hyperparathyroidism (PHPT) include ultrasound of the neck, 99mTc-sestamibi scintigraphy, and four-dimensional computed tomography (4D-CT). However, the role of other imaging modalities, such as 11C-methionine PET/CT, in the care pathway for PHPT is currently unclear. Here, we report our experience of the diagnostic utility of 11C-methionine PET/CT in a single-center patient cohort (n = 45).Design: Retrospective single-center cohort study.Patients and Measurements: The data of eligible patients that underwent 11C-methionine PET/CT between 2014 and 2022 at Addenbrooke's Hospital (Cambridge, UK) were collected and analyzed. The clinical utility of imaging modalities was determined by comparing the imaging result with histopathological and biochemical outcomes following surgery.

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

“…Recently, 11C-methionine, 11C-choline or 18F-fluorocholine PET/CT showed encouraging outcomes, especially in patients who underwent unsuccessful parathyroidectomy or had negative or discordant imaging results pre-surgery, with these patients being alternatively candidates to SPECT/CT, as well [44][45][46][47]. Head-to-head studies (versus 99m-Tc sestamibi SPECT/CT) showed comparable results despite using a different tracer for parathyroid glands [48] or even an improvement in detection rate, for instance, from 88% for 99m-Tc-sestamibi SPECT/CT to 98% according to one recent study [49] or a sensitivity of 99% for 18F-fluorocholine PET/CT versus 75% for ultrasound versus 65% for 99m-Tc sestamibi scintigraphy versus 89.9% for ultrasound combined with this type of scintigraphy according to another cohort from 2022 [50].…”

“…However, the implementation of such a protocol largely depends on each centre standards rather than being a guideline recommendation [60][61][62][63]. Overall, negative or discordant pre-operatory imaging results in PHP do not exclude a successful parathyroidectomy in the hands of a skilled surgeon [44,45].…”