PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism

• Published in: Journal of endocrinological investigation Vol. 42; no. 4; pp. 419 - 426
• Main Authors: Bossert, I., Chytiris, S., Hodolic, M., Croce, L., Mansi, L., Chiovato, L., Mariani, G., Trifirò, G.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-04-2019; Springer Nature B.V
• Subjects: Choline; Computed tomography; Cytology; Endocrine system; Endocrinology; Hypercalcemia; Hyperparathyroidism; Medicine; Medicine & Public Health; Metabolic Diseases; Neck; Original Article; Parathyroid; Scintigraphy; Surgery; Ultrasound; Vitamin D; PETC/CT with 18F-Choline; Primary hyperparathyroidism; Normocalcemic hyperparathyroidism
• ISSN: 1720-8386; 0391-4097; 1720-8386
• DOI: 10.1007/s40618-018-0931-z

Purpose
Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and/or
99m
Tc-Sestamibi scintigraphy, can be challenging. PET/CT with
18
F-Fluorocholine (
18
F-FCH) might improve the detection of pathologic parathyroid glands. We aimed at comparing the diagnostic performance of
18
F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US.
Methods
Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism. All patients underwent high-resolution neck US, dual-phase dual-isotope
99m
Tc-Pertechnetate/
99m
Tc-Sestamibi scintigraphy, and
18
F-FCH-PET/CT.
Results
In the whole patients’ group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for
18
F-FCH-PET/CT, and only 15% for
99m
Tc-Sestamibi scintigraphy. The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were 57 and 70% for neck US, 70 and 71% for
18
F-FCH-PET/CT, and 0 and 18% for
99m
Tc-Sestamibi scintigraphy, respectively. In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology/biochemistry, the correct detection rate was 82% for neck US, 89% for
18
F-FCH-PET/CT, and only 17% for
99m
Tc-Sestamibi scintigraphy.
Conclusions
18
F-FCH-PET/CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small.