The utility of 18F-fluorocholine PET/CT in the imaging of parathyroid adenomas
, 12, 12, 3, 12, 12, 4
Abstract
Introduction: The aim of the study was to estimate the sensitivity of 18F-FCH PET/CT in preoperative localisation of hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism (PHPT).
Material and methods: Sixty-five consecutive patients with PHPT, who underwent neck ultrasound (US) and 99mTc/99mTc-MIBI dual-phase parathyroid scintigraphy, were prospectively enrolled. Twenty-two patients had unsuccessful parathyroid surgery prior to the study. PET/CT scans were performed 65.0 ± 13.3 min after injection of 218.5 ± 31.9 MBq of 18F-fluorocholine (FCH). Three experienced nuclear medicine physicians assessed the detection rate of hyperfunctioning parathyroid tissue. Response to parathyroidectomy and clinical follow-up served as a reference test. Per-patient sensitivity and positive predictive value (PPV) were calculated for patients who underwent surgery.
Results: 18F-FCH PET/CT was positive in 61 patients, and negative in 4. US and parathyroid scintigraphy showed positive and negative results in 20, 45 and 17, 48, respectively. US showed nodular goitre in 31 patients and chronic thyroiditis in 9 patients. Parathyroid surgery was performed in 43 (66%) patients. 18F-FCH PET/CT yielded a sensitivity of 100% (95% CI: 87.99–100) and PPV of 85.7% (95% CI: 70.77–94.06). Similar values were observed in patients with chronic thyroiditis, nodular goitre, and patients after an unsuccessful parathyroid surgery. PET/CT identified hyperparathyroidism complications (kidney stones, osteoporotic bone fractures, and brown tumours) in 11 patients.
Conclusions: 18F-FCH PET/CT effectively detected hyperfunctioning parathyroid tissue and its complications. The method showed excellent sensitivity and positive predictive value, including patients with nodular goitre, chronic thyroiditis, and prior unsuccessful parathyroidectomy. PET/CT performance was superior to neck ultrasound and parathyroid scintigraphy.
Keywords: 18F-FCH PET/CTfluorocholinehyperparathyroidismparathyroid imaging
References
- Cordellat IM. Hyperparathyroidism: primary or secondary disease? Reumatol Clin. 2012; 8(5): 287–291.
- Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism. JAMA Surg. 2016; 151(10): 959–968.
- López-Mora DA, Sizova M, Estorch M, et al. Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas. Eur J Nucl Med Mol Imaging. 2020; 47(3): 572–578.
- Rep S, Lezaic L, Kocjan T, et al. Optimal scan time for evaluation of parathyroid adenoma with [(18)F]-fluorocholine PET/CT. Radiol Oncol. 2015; 49(4): 327–333.
- Taieb D, Hindie E, Grassetto G, et al. Parathyroid scintigraphy: when, how, and why? A concise systematic review. Clin Nucl Med. 2012; 37(6): 568–574.
- Quak E, Blanchard D, Houdu B, et al. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study. Eur J Nucl Med Mol Imaging. 2018; 45(4): 658–666.
- Thier M, Nordenström E, Bergenfelz A, et al. Presentation and Outcomes After Surgery for Primary Hyperparathyroidism During an 18-Year Period. World J Surg. 2016; 40(2): 356–364.
- Hindié E, Mellière D, Perlemuter L, et al. Primary hyperparathyroidism: higher success rate of first surgery after preoperative Tc-99m sestamibi-I-123 subtraction scanning. Radiology. 1997; 204(1): 221–228.
- Hindié E, Ugur O, Fuster D, et al. Parathyroid Task Group of the EANM. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009; 36(7): 1201–1216.
- Roy M, Mazeh H, Chen H, et al. Incidence and localization of ectopic parathyroid adenomas in previously unexplored patients. World J Surg. 2013; 37(1): 102–106.
- Treglia G, Giovannini E, Di Franco D, et al. The role of positron emission tomography using carbon-11 and fluorine-18 choline in tumors other than prostate cancer: a systematic review. Ann Nucl Med. 2012; 26(6): 451–461.
- Rep S, Hocevar M, Vaupotic J, et al. F-choline PET/CT for parathyroid scintigraphy: significantly lower radiation exposure of patients in comparison to conventional nuclear medicine imaging approaches. J Radiol Prot. 2018; 38(1): 343–356.
- Treglia G, Piccardo A, Imperiale A, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2019; 46(3): 751–765.
- Schweighofer-Zwink G, Hehenwarter L, Rendl G, et al. [Imaging of parathyroid adenomas with F‑18 choline PET-CT]. Wien Med Wochenschr. 2019; 169(1-2): 15–24.
- Fischli S, Suter-Widmer I, Nguyen BaT, et al. The Significance of 18F-Fluorocholine-PET/CT as Localizing Imaging Technique in Patients with Primary Hyperparathyroidism and Negative Conventional Imaging. Front Endocrinol (Lausanne). 2017; 8: 380.
- Grimaldi S, Young J, Kamenicky P, et al. Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of F-Fluorocholine PET/CT. Eur J Nucl Med Mol Imaging. 2018; 45(10): 1772–1780.
- Petranović Ovčariček P, Giovanella L, Carrió Gasset I, et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging. 2021; 48(9): 2801–2822.
