18F-fluorocholine PET/CT and conventional imaging in primary hyperparathyroidism

David Dudoignon, Thierry Delbot, Anne Ségolène Cottereau, Amina Dechmi, Marie Bienvenu, Eugénie Koumakis, Catherine Cormier, Sébastien Gaujoux, Lionel Groussin, Béatrix Cochand-Priollet, Jérome Clerc, Myriam Wartski
Diagnostic and Interventional Imaging 2022, 103 (5): 258-265

PURPOSE: The purpose of this study was to assess the diagnostic capabilities of preoperative conventional imaging (99m Tc-MIBI scintigraphy, cervical ultrasonography [CUS]) and 18 F-fluorocholine PET/CT (FCH PET/CT) in the detection of hyperfunctioning parathyroid gland in patients with primary hyperparathyroidism (PHPT) used alone or as a single imaging set.

MATERIALS AND METHODS: A total of 51 consecutive patients (6 men, 45 women; mean age, 62 ± 11.6 [SD] years; age range: 28-86 years) with biochemically confirmed PHPT who underwent CUS, single-tracer dual phase 99m Tc-MIBI scintigraphy and FCH PET/CT were retrospectively included. 99m Tc-MIBI scintigraphy were performed immediately after CUS and interpreted by the same operators. FCH PET/CT examinations were interpreted independently by two nuclear medicine physicians. An additional reading session integrating the three imaging modalities read in consensus as a combined imaging set was performed.

RESULTS: At surgery, 74 lesions were removed (32 parathyroid adenomas, 38 parathyroid hyperplasia and 4 subnormal glands). Thirty-six patients (71%) had single-gland disease and 15 patients (29%) had multiglandular disease at histopathological analysis. On a patient basis, sensitivity and accuracy of FCH PET/CT, CUS and 99m Tc-MIBI scintigraphy for the detection of abnormal parathyroid glands were 76% (95% CI: 63-87%) and 76% (95% CI: 63-87%), 71% (95% CI: 56-83%) and 71% (95% CI: 56-83%), 33% (95% CI: 21-48%) and 33% (95% CI: 21-48%), respectively. The sensitivity of the combined imaging set was 94% (95% CI: 84-99%) and greater than the sensitivity of each individual imaging technique (P ≤ 0.001 for all).

CONCLUSION: Our results suggest that CUS, 99m Tc-MIBI scintigraphy and FCH PET/CT interpreted as a single imaging set could be the ideal practice to precisely localize parathyroid lesion in patients with PHPT before surgery.

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