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18 F-Fluorocholine PET/CT Is More Sensitive Than 11 C-Methionine PET/CT for the Localization of Hyperfunctioning Parathyroid Tissue in Primary Hyperparathyroidism.
- Source :
-
Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2022 May; Vol. 63 (5), pp. 785-791. Date of Electronic Publication: 2021 Aug 19. - Publication Year :
- 2022
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Abstract
- Preoperative molecular imaging is paramount to direct surgery in primary hyperparathyroidism (pHPT). We investigated the diagnostic performance of <superscript>18</superscript> F-fluorocholine ( <superscript>18</superscript> F-FCH) PET/CT compared with <superscript>11</superscript> C-methionine ( <superscript>11</superscript> C-MET) PET/CT for localization of hyperfunctioning parathyroid tissue in patients with pHPT and negative or inconclusive <superscript>99m</superscript> Tc-sestaMIBI ( <superscript>99m</superscript> Tc-MIBI) SPECT findings. Methods: Fifty-eight patients with biochemical evidence of pHPT and negative or inconclusive <superscript>99m</superscript> Tc-MIBI SPECT findings were referred for presurgical detection and localization of hyperfunctioning parathyroid tissue by <superscript>11</superscript> C-MET and <superscript>18</superscript> F-FCH PET/CT. The PET/CT results were classified into 3 categories (positive, inconclusive, or negative) based on the nodular aspect of tracer uptake and the visualization of corresponding nodules on CT. The PET/CT results were correlated with the surgical and histopathologic findings, which were used as the gold standard. Results: Fifty-three patients were included for analysis. <superscript>18</superscript> F-FCH PET/CT was positive in 39 patients (74%), inconclusive in 5 (9%), and negative in 9 (17%), compared with 25 (47%), 12 (23%), and 16 (30%), respectively, for <superscript>11</superscript> C-MET PET/CT. <superscript>18</superscript> F-FCH localized 11 additional foci (6 positive and 5 inconclusive), compared with <superscript>11</superscript> C-MET. Twenty-six patients (sex ratio, 10/16 M/F) underwent surgery, with resection of 31 lesions (22 adenomas, 6 hyperplastic glands, and 3 carcinomas) and 1 normal gland. At follow-up, 21 patients (81%) were considered cured after surgery, whereas 3 patients (12%) had persistence of hypercalcemia. With inconclusive cases being considered negative, <superscript>18</superscript> F-FCH PET/CT correctly localized 26 lesions in 24 of 26 patients (92%), compared with 16 lesions in 15 of 26 patients (58%) localized by <superscript>11</superscript> C-MET PET/CT. Per-patient-based sensitivity and positive predictive value were 96% and 96%, respectively, for <superscript>18</superscript> F-FCH and 60% and 94%, respectively, for <superscript>11</superscript> C-MET ( P < 0.0001). Per-lesion-based sensitivity and positive predictive value were 84% and 90%, respectively, for <superscript>18</superscript> F-FCH and 52% and 94%, respectively, for <superscript>11</superscript> C-MET ( P < 0.0001). Conclusion: In the presence of biochemical evidence of pHPT with negative or inconclusive <superscript>99m</superscript> Tc-MIBI SPECT findings, <superscript>18</superscript> F-FCH PET/CT performs better than <superscript>11</superscript> C-MET PET/CT for the detection of pathologic parathyroid tissue, allowing localization of parathyroid adenoma or hyperplasia in 96% of patients.<br /> (© 2022 by the Society of Nuclear Medicine and Molecular Imaging.)
- Subjects :
- Choline analogs & derivatives
Humans
Methionine
Parathyroid Glands diagnostic imaging
Parathyroid Glands pathology
Parathyroid Glands surgery
Technetium Tc 99m Sestamibi
Hyperparathyroidism, Primary diagnostic imaging
Hyperparathyroidism, Primary pathology
Positron Emission Tomography Computed Tomography methods
Subjects
Details
- Language :
- English
- ISSN :
- 1535-5667
- Volume :
- 63
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Journal of nuclear medicine : official publication, Society of Nuclear Medicine
- Publication Type :
- Academic Journal
- Accession number :
- 34413141
- Full Text :
- https://doi.org/10.2967/jnumed.121.262395