scholarly journals A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism

Medicine ◽  
2015 ◽  
Vol 94 (41) ◽  
pp. e1701 ◽  
Author(s):  
Laure Michaud ◽  
Sona Balogova ◽  
Alice Burgess ◽  
Jessica Ohnona ◽  
Virginie Huchet ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Dual Phase ◽  
Dual Isotope ◽  
Pet Ct ◽  
99Mtc Sestamibi

scholarly journals Is 18F-Fluorocholine-Positron Emission Tomography/Computerized Tomography a New Imaging Tool for Detecting Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism?

2014 ◽  
Vol 99 (12) ◽  
pp. 4531-4536 ◽  
Author(s):  
Laure Michaud ◽  
Alice Burgess ◽  
Virginie Huchet ◽  
Marine Lefèvre ◽  
Marc Tassart ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Secondary Hyperparathyroidism ◽  
Functional Imaging ◽  
Imaging Modality ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Preoperative Ultrasonography ◽  
99Mtc Sestamibi

Context: Preoperative ultrasonography and scintigraphy using 99mTc-sestamibi are commonly used to localize abnormal parathyroid glands. In cases of discrepant results between scintigraphy and ultrasonography, it is important to rely on another diagnostic imaging modality. 18F-fluorodeoxyglucose (FDG) and 11C-methionine positron emission tomography (PET) have been studied, but are imperfect to detect abnormal parathyroid glands. Recently, first cases of abnormal parathyroid glands taking-up radiolabelled choline were discovered incidentally in men referred to 11C-choline or 18F-fluorocholine (FCH)-PET/CT for prostate cancer. We checked if FCH uptake was a general feature of adenomatous or hyperplastic parathyroid glands. Methods: FCH-PET/CT was performed in 12 patients with primary (n = 8) or secondary hyperparathyroidism (1 dialyzed, 3 grafted) and with discordant or equivocal results on preoperative ultrasonography (US) and/or 123I/99mTc-sestamibi dual-phase scintigraphy. The results of the FCH-PET/CT were evaluated, with surgical exploration and histopathologic examination as the standard of truth. Results: On a per-patient level, the detection rate of FCH-PET/CT (at least one FCH focus corresponding to an abnormal parathyroid gland in a given patient) was 11/12 = 92%. FCH-PET/CT detected 18 foci interpreted as parathyroid glands and correctly localized 17 abnormal parathyroid glands (7 adenomas and 10 hyperplasias). On a per-lesion level, FCH-PET/CT results were 17 TP, 2 false negative ie, a lesion-based sensitivity of 89%, and 1 false positive. Conclusion: As the main result of this pilot study, we show that in patients with hyperparathyroidism and with discordant or equivocal results on scintigraphy or on ultrasonography, adenomatous or hyperplastic parathyroid glands can be localized by FCH-PET/CT with good accuracy. Furthermore, FCH-PET/CT can solve discrepant results between preoperative ultrasonography and scintigraphy and has thus a potential as a functional imaging modality in the detection of abnormal parathyroid glands. Our preliminary results are encouraging and prompt us to further evaluate FCH-PET/CT as a functional imaging agent in patients with biochemical hyperparathyroidism.

Ultrasonography for preoperative localization of enlarged parathyroid glands in secondary hyperparathyroidism

2009 ◽  
Vol 36 (4) ◽  
pp. 461-465 ◽  
Author(s):  
Ryo Kawata ◽  
Lee Kotetsu ◽  
Atsuko Takamaki ◽  
Katsuhiro Yoshimura ◽  
Hiroshi Takenaka
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Parathyroid Glands ◽  
Preoperative Localization

scholarly journals Can Met-PET/CT Predict Sporadic Multiglandular Hyperparathyroidism? Report of a Case and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Andreas Hillenbrand ◽  
Johannes Lemke ◽  
Doris Henne-Bruns ◽  
Ambros J. Beer ◽  
Vikas Prasad
Keyword(s):  
Posterior Mediastinum ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Surgical Removal ◽  
Increased Risk ◽  
Pet Ct ◽  
Parathyroid Adenomas ◽  
Patients At Risk ◽  
Ectopic Parathyroid ◽  
Met Pet

Background. Primary hyperparathyroidism (pHPT) is a common endocrine disorder of the parathyroid glands. In most cases pHPT is caused by single gland disease, but about 10% of patients suffer from sporadic multiglandular disease (MGD). Patients with MGD, especially with ectopic parathyroid adenomas, have an increased risk for persistence/recurrence after surgery. Normally, sporadic MGD cannot be diagnosed preoperatively by parathyroid scintigraphy. We analyzed the potential of positron emission tomography/computed tomography (Met-PET/CT) to predict MGD. Methods and Case Presentation. We reviewed the literature, if preoperative Met-PET/CT could predict MGD in patients with pHPT. Further, we present a 71-year-old female with ectopic MGD. Preoperative localization via Met-PET/CT showed MGD with two areas suspected to be enlarged parathyroid glands (left lateral to the thyroid lobe and posterior mediastinum). Both diagnostic findings were extirpated and parathormone dropped into normal levels. Results. We identified four additional manuscripts, referring to MGD and Met-PET/CT with divergent results. Preoperative localization diagnostics using Met-PET/CT may not necessarily identify MGD. In most cases, Met-PET/CT localized only one adenoma and localizes larger adenomas more reliably than smaller adenomas. Conclusion. Identifying patients at risk of MGD preoperatively remains challenging. We found MET-PET/CT seems to predict MGD in patients with large size and high weight PTH adenomas. For ectopic parathyroid adenomas, accurate preoperative localization is the key to successful surgical removal. Met-PET/CT appears to have great potential in soft-tissue analysis of complex anatomical regions and can predict ectopic parathyroid adenomas.

scholarly journals Pathological uptake with 18-Fluorocholine versus 99mTc-MIBI in the location of the parathyroid glands in hyperparathyroidism. Systematic review and meta-analysis

2020 ◽  
Author(s):  
Jose Luis Pardal-Refoyo ◽  
Pilar Tamayo-Alonso ◽  
Sofia Ferreira-Cendon ◽  
Esther Martin-Gomez
Keyword(s):  
Systematic Review ◽  
Random Effects ◽  
Meta Analysis ◽  
Probability Of Detection ◽  
Parathyroid Glands ◽  
Random Effects Model ◽  
Number Of Patients ◽  
Pet Ct ◽  
Sestamibi Scan ◽  
99Mtc Sestamibi

Introduction: The location of the pathological parathyroid glands in hyperparathyroidism is usually carried out by means of 99mTc-sestamibi scintigraphy, which increases its precision by adding the ultrasound examination. The non-localization of the parathyroid glands increases the difficulties for surgical removal. To increase the detection of pathological glands, other radioactive tracers are used, such as methionine, fluorocholine or 18F-flurpiridaz. Objective: To establish if PET / CT with 18-Fluorocholine in patients with hyperparathyroidism increases the number of uptakes compared to the 99mTc-sestamibi scan. Method: Systematic review and meta-analysis. Two subgroups were analyzed. Subgroup 1: trials comparing both techniques as an initial exploration. Thirteen studies including 1131 examinations were selected (596 PET / CT with 18-Fluorocholine vs. 535 scintigraphy with 99mTc-sestamibi). Meta-analysis was performed following the random effects model and the odds ratio was calculated. Subgroup 2: studies that include 18-Fluorocholine as a rescue examination in patients with a previous negative study with a 99mTc-sestamibi scan. 17 articles including 412 examinations with 359 patients in which there was at least one uptake were selected. Meta-analysis of the prevalence of the number of patients in whom there was at least one uptake was performed using the random effects model. Results: Subgroup 1: The number of patients in which at least one uptake occurs is significantly higher with the 18-Fluorocholine examinations (OR 4.264, 95% CI 2.400-7.577). The prevalence of uptake with 18-Fluorocholine is 0.91 [0.86, 0.95] and with sestamibi 0.68 [0.56, 0.80]. Subgroup 2: the prevalence of uptake among patients with previous negative MIBI studies was 0.90 [0.87, 0.94]. The probability of detection of both techniques in this group reaches 0.98. Publication bias in the meta-analyzes is low. Discussion: 18-Fluorocholine protocols provide higher precision, clearer images, with faster acquisition as well as being readily available for most PET / CT centers. Conclusion: The PET / CT study with 18-Fluorocholine can be recommended as a study for the location of pathological parathyroid glands after studies with negative MIBI.

scholarly journals Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism

2020 ◽  
Author(s):  
Rongqin Zhang ◽  
Zhanwen Zhang ◽  
Pinbo Huang ◽  
Zhi Li ◽  
Rui Hu ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Diagnostic Performance ◽  
Serum Alkaline Phosphatase ◽  
Parathyroid Glands ◽  
Dual Phase ◽  
Spearman Correlation ◽  
99Mtc Mibi ◽  
Mibi Scintigraphy ◽  
Mibi Spect ◽  
Higher Sensitivity

Abstract Background: Secondary hyperparathyroidism (SHPT) usually requires parathyroidectomy when drug regimens fail. However, obtaining an exact preoperative map of the locations of the parathyroid glands is a challenge. The purpose of this study was to compare the diagnostic performance of US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT in patients with SHPT.Methods: Sixty patients with SHPT who were undergoing dialysis were evaluated preoperatively by US, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT/CT. Postoperative pathology served as the gold standard. The sensitivity, specificity, and accuracy were determined for each method. Spearman correlation analysis was used to analyse the correlation of hyperplastic parathyroid calcification with serum alkaline phosphatase (ALP) and parathyroid hormone (PTH).Results: A total of 229 lesions in 60 patients were pathologically confirmed to be parathyroid hyperplasia, with 209 lesions in typical sites, 15 lesions in the upper mediastinum and 5 lesions in the thyroid. A total of 88.33% (53/60) of patients had four lesions. US, early and delayed 99mTc-MIBI SPECT/CT had significantly higher sensitivity and accuracy than dual-phase 99mTc-MIBI scintigraphy (P < 0.001). Furthermore, early 99mTc-MIBI SPECT/CT had significantly higher sensitivity (P < 0.001) and accuracy (P = 0.001 and P < 0.001) than US and delayed 99mTc-MIBI SPECT/CT. In patients with ectopic hyperplastic parathyroid glands, the sensitivity of early 99mTc-MIBI SPECT/CT (90%) was significantly higher than that of US (55%) and dual-phase 99mTc-MIBI scintigraphy (50%) (P < 0.05). The Spearman correlation results showed a significant linear association between calcification and both serum PTH and ALP (P = 0.002).Conclusion: The ability of early 99mTc-MIBI SPECT/CT to detect hyperplastic parathyroid glands in patients with SHPT is superior to that of US, dual-phase 99mTc-MIBI scintigraphy and delayed 99mTc-MIBI SPECT/CT; furthermore, dual-phase 99mTc-MIBI SPECT/CT is not essential.

scholarly journals Incidental uptake of 18F-fluorocholine (FCH) in the head or in the neck of patients with prostate cancer

2014 ◽  
Vol 48 (3) ◽  
pp. 228-234 ◽  
Author(s):  
Marina Hodolic ◽  
Virginie Huchet ◽  
Sona Balogova ◽  
Laure Michaud ◽  
Khaldoun Kerrou ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Pituitary Adenomas ◽  
Final Diagnosis ◽  
Parathyroid Glands ◽  
Correlative Imaging ◽  
Positron Emission ◽  
Pet Ct ◽  
Multiple Bone Metastases ◽  
Benign Tumours ◽  
99Mtc Sestamibi

Abstract Background. Positron emission tomography-computed tomography (PET/CT) with 18F-fluorocholine (FCH) is routinely performed in patients with prostate cancer. In this clinical context, foci of FCH uptake in the head or in the neck were considered as incidentalomas, except for those suggestive of multiple bone metastases. Results. In 8 patients the incidental focus corresponded to a benign tumour. The standard of truth was histology in two cases, correlative imaging with MRI in four cases, 99mTc-SestaMIBI scintigraphy, ultrasonography and biochemistry in one case and biochemistry including PTH assay in one case. The final diagnosis of benign tumours consisted in 3 pituitary adenomas, 2 meningiomas, 2 hyperfunctioning parathyroid glands and 1 thyroid adenoma. Malignancy was proven histologically in 2 other patients: 1 papillary carcinoma of the thyroid and 1 cerebellar metastasis. Conclusions. To the best of our knowledge, FCH uptake by pituitary adenomas or hyperfunctioning parathyroid glands has never been described previously. We thus discuss whether there might be a future indication for FCH PET/ CT when one such tumour is already known or suspected: to detect a residual or recurrent pituitary adenoma after surgery, to guide surgery or radiotherapy of a meningioma or to localise a hyperfunctioning parathyroid gland. In these potential indications, comparative studies with reference PET tracers or with 99mTc-sestaMIBI in case of hyperparathyroidism could be undertaken.

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