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

doi:10.1016/j.diii.2021.12.005

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

Diagn Interv Imaging. 2022 May;103(5):258-265. doi: 10.1016/j.diii.2021.12.005. Epub 2022 Jan 14.

Affiliations

¹ Department of Nuclear Medicine, Paris Centre University, Cochin Hospital, AP-HP, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France. Electronic address: david.dudoignon@aphp.fr.
² Department of Nuclear Medicine, Paris Centre University, Cochin Hospital, AP-HP, 75014 Paris, France.
³ Department of Nuclear Medicine, Paris Centre University, Cochin Hospital, AP-HP, 75014 Paris, France; Université de Paris, Faculté de Médecine, 75006 Paris, France.
⁴ Department of Rheumatology, Paris Centre University, Cochin Hospital, AP-HP, 75014 Paris, France.
⁵ Department of Surgery, Sorbonne Université, La Pitié-Salpétrière Hospital, AP-HP, 75013 Paris, France.
⁶ Department of Endocrinology, Paris Centre University, Cochin Hospital, AP-HP, 75014 Paris, France.
⁷ Université de Paris, Faculté de Médecine, 75006 Paris, France; Department of Pathology, Paris Centre University, Cochin Hospital, AP-HP, 75014 Paris, France.

PMID: 35039246
DOI: 10.1016/j.diii.2021.12.005

Abstract

Purpose: The purpose of this study was to assess the diagnostic capabilities of preoperative conventional imaging (^99mTc-MIBI scintigraphy, cervical ultrasonography [CUS]) and ¹⁸F-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 ^99mTc-MIBI scintigraphy and FCH PET/CT were retrospectively included. ^99mTc-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 ^99mTc-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, ^99mTc-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.

Keywords: 18F-fluorocholine PET/CT; 99mTc-MIBI scintigraphy; Cervical ultrasonography; Comparative studies; Primary hyperparathyroidism.

MeSH terms

Adult
Aged
Aged, 80 and over
Choline / analogs & derivatives
Female
Humans
Hyperparathyroidism, Primary* / diagnostic imaging
Hyperparathyroidism, Primary* / pathology
Hyperparathyroidism, Primary* / surgery
Male
Middle Aged
Parathyroid Glands / diagnostic imaging
Parathyroid Glands / pathology
Parathyroid Glands / surgery
Positron Emission Tomography Computed Tomography* / methods
Retrospective Studies
Technetium Tc 99m Sestamibi

Substances

fluorocholine
Technetium Tc 99m Sestamibi
Choline