Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

Noltes, Milou; Coester, Annemieke M.; Horst-Schrivers, Anouk N A van der; Dorgelo, Bart; Jansen, Liesbeth; Noordzij, Walter; Lemstra, Clara; Brouwers, Adrienne H.; Kruijff, Schelto

doi:10.1007/s00423-017-1549-x

Cited by 30 publications

(41 citation statements)

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“…In previous studies, 11 C-methionine has been shown to be of great value, especially, but not only, in the setting of negative 99m Tc-sestamibi results (14)(15)(16)(17). The pooled sensitivity in a metaanalysis of 9 studies with a total of 137 patients was found to be 86% (24).…”

Section: Discussionmentioning

confidence: 93%

“…Therefore, problems arise if neither imaging modality can locate the PTA or if the results obtained by imaging are inconclusive or discordant. 11 C-methionine PET/CT has been successfully applied in this setting (14)(15)(16)(17)(18). During the last few years, radiolabeled choline has been increasingly used to localize PTAs, with high sensitivities reported (19)(20)(21)(22).…”

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confidence: 99%

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Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

et al. 2019

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We aimed to assess the value of 11 C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99m Tc-sestamibi imaging and neck ultrasound. Methods: Eightyseven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUV max and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11 C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had falsepositive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUV max was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11 C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99m Tc-sestamibi imaging yield negative or discordant results.

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Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

et al. 2019

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“…13 ZT can also be confused with a parathyroid adenoma, especially in patients with primary hyperparathyroidism. In a previous report reviewing primary hyperparathyroidism, 25 there were some cases in which the findings of a diagnostic imaging study such as [ 11 C]methionine PET/CT were positive but the surgeon could not locate the adenoma during the operation. We believe that some of these cases might have resulted from confusion of the ZTs with parathyroid adenomas.…”

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confidence: 99%

Zuckerkandl Tubercle of the Thyroid Gland: Correlations between Findings of Anatomic Dissections and CT Imaging

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Kwak

et al. 2017

AJNR Am J Neuroradiol

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“…Lately, new functional imaging techniques using positron emission tomography (PET)/CT, with, e.g., 11 C-methionine [8, 9] as radiotracer, have been studied, but no ideal PET tracer for adenomas has emerged so far. Recently, 11 C/ 18 F-choline was reported for visualization of adenomas and favorable results have been published in literature [10–15].…”

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confidence: 99%

Optimization of parathyroid 11C-choline PET protocol for localization of parathyroid adenomas in patients with primary hyperparathyroidism

et al. 2019

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Purpose To evaluate the optimal tracer uptake time, the minimal amount of radioactivity and the inter-observer agreement for 11 C-choline positron emission tomography/computed tomography (PET/CT) in patients with primary hyperparathyroidism (pHPT). Methods Twenty-one patients with biochemically proven pHPT were retrospectively studied after injection of 6.3 ± 1.2 MBq/kg 11 C-choline. PET data of the first nine patients, scanned for up to 60 min, were reconstructed in 10-min frames from 10- to 60-min postinjection (p.i.), mimicking varying 11 C-choline uptake times. Parathyroid adenoma to background contrast ratios were calculated and compared, using standardized uptake values (SUVs). Data was reconstructed with varying scan durations (1, 2.5, 5, and 10 min) at 20–30-min p.i. (established optimal uptake time), mimicking less administered radioactivity. To establish the minimal required radioactivity, the SUVs in the shorter scan durations (1, 2.5, and 5 min) were compared to the 10-min scan duration to determine whether increased variability and/or statistical differences were observed. Four observers analyzed the 11 C-choline PET/CT in four randomized rounds for all patients. Results SUVpeak of the adenoma decreased from 30 to 40 p.i. onwards. All adenoma/background contrast ratios did not differ from 20- to 30-min p.i. onwards. The SUVs of adenoma in the scan duration of 1, 2.5, and 5 min all differed significantly from the same SUV in the 10-min scan duration (all p = 0.012). However, the difference in absolute SUV adenoma values was well below 10% and therefore not considered clinically significant. The inter-observer analysis showed that the Fleiss’ kappa of the 1-min scan were classified as “moderate,” while these values were classified as “good” in the 2.5-, 5-, and 10-min scan duration. Observers scored lower certainty scores in the 1- and 2.5-min scans compared to the 5- and 10-min scan durations. Conclusion The optimal time to start PET/CT scanning in patients with pHPT is 20 min after mean injection of 6.3 MBq/kg 11 C-choline, with a recommended scan duration of at least 5 min. Alternatively, the radioactivity dose can be lowered by 50% while keeping a 10-min scan duration without losing the accuracy of 11 C-choline PET/CT interpretation. Electronic supplementary material The online version of this article (10.1186/s13550-019-0534-5) contains supplementary material, which is available to authorized users.

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Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

Cited by 30 publications

References 30 publications

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Zuckerkandl Tubercle of the Thyroid Gland: Correlations between Findings of Anatomic Dissections and CT Imaging

Optimization of parathyroid 11C-choline PET protocol for localization of parathyroid adenomas in patients with primary hyperparathyroidism

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Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

Cited by 30 publications

References 30 publications

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT

Zuckerkandl Tubercle of the Thyroid Gland: Correlations between Findings of Anatomic Dissections and CT Imaging

Optimization of parathyroid 11C-choline PET protocol for localization of parathyroid adenomas in patients with primary hyperparathyroidism

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Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT