MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

Sacconi, Beatrice; Argirò, Renato; Diacinti, Daniele; Iannarelli, Angelo; Bezzi, Mario; Cipriani, Cristiana; Pisani, Daniela; Cipolla, Valentina; Felice, Carlo de; Minisola, Salvatore; Catalano, Carlo

doi:10.1007/s00330-015-3854-5

Cited by 27 publications

(15 citation statements)

References 70 publications

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“…MR imaging alone has been shown to allow accurate localization of abnormal parathyroid glands (12,26). Because of the lack of adipose tissue in parathyroid adenomas, high signal intensity on T2-weighted images is seen typically at MR imaging, which enables detection of adenomas (27). Because of advances in technology, its accuracy has increased even further with the use of dynamic contrast materialenhanced imaging (16).…”

Section: Discussionmentioning

confidence: 99%

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

et al. 2017

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Purpose To investigate the performance of flourine 18 (F) fluorocholine (FCH) positron emission tomography (PET)/magnetic resonance (MR) imaging in patients with hyperparathyroidism and nonlocalized disease who have negative or inconclusive results at ultrasonography (US) and technetium 99m (Tc) sestamibi scintigraphy. Materials and Methods This study was approved by the institutional review board. Between May and December 2015, 10 patients (mean age, 70.4 years; range, 58-82 years) with biochemical primary hyperparathyroidism and inconclusive results at US and Tc sestamibi scintigraphy were prospectively enrolled. All patients gave informed consent. Directly after administration of 3 MBq/kg of FCH, PET imaging was performed, followed by T1- and T2-weighted MR imaging before and after gadolinium enhancement. Intraoperative localization and histologic results were the reference standard for calculating sensitivity and positive predictive value. The Wilcoxon rank test was used to calculate the mean difference in maximum standardized uptake value (SUV) between abnormal parathyroid uptake and physiologic thyroid uptake. The Wilcoxon rank-sum test was performed. Results MR imaging alone showed true-positive lesions in five patients and a false-positive lesion in one patient. FCH PET/MR imaging allowed correct localization of nine of 10 adenomas (90% sensitivity), without any false-positive results (100% positive predictive value). One patient had four-gland hyperplasia, of which three hyperplastic glands were not localized. The median SUV of the nine preoperatively identified adenomas was 4.9 (interquartile range, 2.45-7.35), which was significantly higher than the SUV, 2.7 (interquartile range, 1.6-3.8), of the thyroid (P = .008). Conclusion FCH PET/MR imaging allowed localization of adenomas with high accuracy when conventional imaging results were inconclusive and provided detailed anatomic information. More patients must be examined to confirm our initial results, and the accuracy of FCH PET/MR imaging for localization of glands in patients with four-gland hyperplasia remains to be investigated. RSNA, 2017.

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Section: Discussionmentioning

confidence: 99%

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

et al. 2017

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“…MRI can also be used to localize parathyroid glands. Evidence remains scarce, but one of the largest studies so far showed a sensitivity of 82 % with a PPV of 89 % and a very recent publication also showed promising results [51, 52]. Considering the unique benefits of 18F-FCH PET and MRI, a potentially superior modality would be using the 18F-FCH tracer and a combined PET MRI scanner.…”

Section: Discussionmentioning

confidence: 99%

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Kluijfhout

Pasternak

Drake

et al. 2016

Langenbecks Arch Surg

109

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Purpose The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers. Methods A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance. Conclusions The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPVand may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.

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“…The use of MRI allows the evaluation of parathyroid anatomy, detection of ectopic glands, in the absence of patient's radiation exposure; reported sensitivity is 80% with the 1.5 T magnets (14). Better visualization has recently been obtained with the use of 3.0 T MRI magnet as a valid method for parathyroid lesions identification, particularly in PHPT patients with negative first-line imaging (15,16 About 30 years ago, when we started to be interested in PHPT (17), the only clinical task was to make the diagnosis. Imaging of the parathyroid glands was an almost unexplored field and patients were immediately referred to the surgeon with expertise in neck operation.…”

Section: Introductionmentioning

confidence: 99%

Imaging of the parathyroid glands in primary hyperparathyroidism

Minisola¹,

Cipriani²,

Diacinti³

et al. 2016

European Journal of Endocrinology

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Primary hyperparathyroidism (PHPT) is one of the most frequent endocrine diseases worldwide. Surgery is the only potentially curable option for patients with this disorder, even though in asymptomatic patients 50 years of age or older without end organ complications, a conservative treatment may be a possible alternative. Bilateral neck exploration under general anaesthesia has been the standard for the definitive treatment. However, significant improvements in preoperative imaging, together with the implementation of rapid parathyroid hormone determination, have determined an increased implementation of focused, minimally invasive surgical approach. Surgeons prefer to have a localization study before an operation (both in the classical scenario and in the minimally invasive procedure). They are not satisfied by having been referred a patient with just a biochemical diagnosis of PHPT. Imaging studies must not be utilized to make the diagnosis of PHPT. They should be obtained to both assist in determining disease etiology and to guide operative procedures together with the nuclear medicine doctor and, most importantly, with the surgeon. On the contrary, apart from minimally invasive procedures in which localization procedures are an obligate choice, some surgeons believe that literature on parathyroidectomy over the past two decades reveals a bias towards localization. Therefore, surgical expertise is more important than the search for abnormal parathyroid glands.

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MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

Abstract: 3 T MRI protocol based on T2-weighted IDEAL FSE sequences was used. T2-hyperintensity and elongated morphology are common features of PTAs. 3 T MRI could be used in the preoperative detection of PTAs.

Cited by 27 publications

References 70 publications

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Imaging of the parathyroid glands in primary hyperparathyroidism

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MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization

Abstract: 3 T MRI protocol based on T2-weighted IDEAL FSE sequences was used. T2-hyperintensity and elongated morphology are common features of PTAs. 3 T MRI could be used in the preoperative detection of PTAs.

Cited by 27 publications

References 70 publications

18F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

18F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Imaging of the parathyroid glands in primary hyperparathyroidism

Contact Info

Product

Resources

About

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study

¹⁸F Fluorocholine PET/MR Imaging in Patients with Primary Hyperparathyroidism and Inconclusive Conventional Imaging: A Prospective Pilot Study