11 C-Choline PET/CT vs. 99m Tc-MIBI/ 123 Iodide Subtraction SPECT/CT for Preoperative Detection of Abnormal Parathyroid Glands in Primary Hyperparathyroidism: A Prospective, Single-Centre Clinical Trial in 60 Patients

Afefah Ismail, Julie Wulf Christensen, Martin Krakauer, Susanne Bonnichsen Søndergaard, Bo Zerahn, Birte Nygaard, Finn Noe Bennedbæk, Bent Kristensen, Lars Thorbjørn Jensen
Diagnostics 2020 November 19, 10 (11)

BACKGROUND: In patients with primary hyperparathyroidism (PHPT) locating hyperfunctioning glands (HPGs) is crucial when planning minimally invasive surgery. Dual-isotope subtraction scintigraphy with 99m Tc-MIBI/123 Iodide using SPECT/CT and planar pinhole imaging (Method A) has previously shown a sensitivity >93%. However, the method is costly and time consuming and entails a high radiation dose. 11 C-Choline PET/CT (Method B) is an appealing candidate method unencumbered by these disadvantages.

METHODS: Sixty patients with newly diagnosed PHPT participated and were scanned using both methods prior to parathyroidectomy. We investigated whether sensitivities of Method A and Method B are similar in a method-to-method comparison when using surgical findings as the true location.

RESULTS: At the patient level, sensitivities were (A) 0.98 (95% CI: 0.90-1.00) and (B) 1.00 (95% CI: 0.93-1.00). At the gland level, sensitivities were (A) 0.88 (95% CI: 0.78-0.94) and (B) 0.87 (95% CI: 0.76-0.92). With a non-inferiority margin of ∆ = -0.1, we found a 1-sided p -value < 0.001.

CONCLUSION: Our methods comparison study found that sensitivity of Method B was not inferior to Method A. We suggest that 11 C-Choline PET/CT is a clinically relevant first-choice candidate for preoperative imaging of PHPT and that Method B can likely replace Method A in the near future.

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