scholarly journals Locating hyperfunctioning parathyroid glands using 11C-Choline PET/CT: an inter- and intra-observer variation study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Julie Wulf Christensen ◽  
Lars Thorbjørn Jensen ◽  
Susanne Bonnichsen Søndergaard ◽  
Rikke Broholm ◽  
Christian Haarmark ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Gold Standard ◽  
Good Clinical Practice ◽  
Observer Variation ◽  
Ethics Committee ◽  
Parathyroid Glands ◽  
Observer Agreement ◽  
Moderate Number ◽  
Choline Pet ◽  
Pet Ct

Abstract Background Use of 11C-Choline PET/CT is gaining ground in detecting hyperfunctioning parathyroid glands in primary hyperparathyroidism. The purpose of this study was to evaluate the robustness of 11C-Choline PET/CT by assessing intra- and inter-observer agreement to determine whether the method was reader sensitive and therefore should only be performed at highly specialised sites with a high number of cases. PET/CT images of 40 patients diagnosed with primary hyperparathyroidism were anonymised and evaluated three times by three readers: an expert reader and two non-experts (non-experts were experienced in PET/CT imaging, but not in 11C-Choline PET/CT in the setting of primary hyperparathyroidism). Number of hyperfunctioning parathyroid glands, location relative to the thyroid gland and confidence of each assessment (low, moderate or high) were noted, and intra- and inter-observer agreement calculated using Fleiss’ kappa method. Sensitivities and specificities of the non-experts were calculated using the expert reader as gold standard. Results Intra-observer agreement was ‘good’ to ‘near perfect’ for all readers. Inter-observer agreement was good between non-experts and the expert, with kappa values ≥ 0.74. Sensitivities between non-experts and the expert were high, > 81%, when assessing which side and 75% when assessing thyroid quadrant. All specificities were > 94%. Reader certainties were ‘high’ in > 80% of cases for the expert and > 70% and > 65%, respectively for the two non-experts. Conclusion 11C-Choline PET/CT is not reader sensitive for the localisation of hyperfunctioning parathyroid glands and may therefore be safely implemented at sites that have a moderate number of cases. Access to a cyclotron laboratory is, however, a necessity for the production of 11C-Choline. The study was conducted in accordance with the Helsinki 2 declaration and The International Council for Harmonisation Guideline for Good Clinical Practice (ICH_GCP) clinical trial, approved by the Research Ethics Committee of the Capital Region of Denmark (Journal-nr.:H-18012490, date of approval: 18 June 2018) and the Danish Medicines Agency (EudraCT no. 2018-000726-63, date of approval: 6 June 2018). The GCP unit in Eastern Denmark has carried out regular monitoring of the trial according to GCP (ID: 2018-1050).

scholarly journals A retrospective analysis of the diagnostic performance of 11C-choline PET/CT for detection of hyperfunctioning parathyroid glands after prior negative or discordant imaging in primary hyperparathyroidism

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. E. Noltes ◽  
S. Kruijff ◽  
L. Jansen ◽  
H. E. Westerlaan ◽  
W. T. Zandee ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Diagnostic Performance ◽  
Histopathological Examination ◽  
Parathyroid Glands ◽  
First Line ◽  
Choline Pet ◽  
Imaging Results ◽  
Pet Ct ◽  
Parathyroid Lesions ◽  
Line Imaging

Abstract Background Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a next in-line scan after primary negative or discordant first-line imaging. Methods This was a retrospective single-center cohort study. All patients with pHPT that were scanned utilizing 11C-choline PET/CT, after prior negative or discordant imaging, between 2015 and 2019 and who subsequently underwent parathyroid surgery were included. The results of the 11C-choline PET/CT were evaluated lesion-based, with surgical exploration and histopathological examination as the gold standard. Results In total, 36 patients were included of which three patients were known to have Multiple Endocrine Neoplasia (MEN) syndrome. In these 36 patients, 40 lesions were identified on 11C-choline PET/CT and 37 parathyroid lesions were surgically removed. In 34/36 (94%) patients a focused parathyroidectomy was performed, in one patient a cervical exploration due to an ectopically identified adenoma, and in one patient a bilateral exploration was performed because of a double adenoma. Overall, per-lesion sensitivity of 11C-choline PET/CT was 97%, the positive predictive value was 95% and the accuracy was 94% for all parathyroid lesions. Conclusions In patients with pHPT and prior negative or discordant first-line imaging results, pathological parathyroid glands can be localized by 11C-choline PET/CT with high sensitivity and accuracy.

18Fluoro-choline PET/CT is a useful tool for patients with primary hyperparathyroidism negative at first-line imaging localization tecniques

2020 ◽  
Author(s):  
Matteo Apicella ◽  
Stefano Bola ◽  
Duccio Volterrani ◽  
Laura Mazoni ◽  
Gianluca Frustaci ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
First Line ◽  
Choline Pet ◽  
Pet Ct ◽  
Line Imaging

18F-Choline PET/CT, MRI, and Software-Based Image Fusion Analysis in Patients With Primary Hyperparathyroidism

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Thomas Hofer ◽  
Juergen Kronbichler ◽  
Helmut Huber ◽  
Benedikt Hergan ◽  
Bernhard Kaiser ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Image Fusion ◽  
Choline Pet ◽  
Pet Ct ◽  
Fusion Analysis

scholarly journals Parathyroid Imaging by 18F-Fluorocholine PET/CT in Patients With Primary Hyperparathyroidism and Inconclusive Conventional Methods: Clinico-Pathological Correlations

2018 ◽  
pp. S551-S557 ◽  
Author(s):  
K. ZAJÍČKOVÁ ◽  
D. ZOGALA ◽  
J. KUBINYI
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Mean Size ◽  
Parathyroid Imaging ◽  
Mibi Scintigraphy

18F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and 99Tc-sestaMIBI SPECT (MIBI) scintigraphy in patients with primary hyperparathyroidism (PHPT) to localize abnormal parathyroid glands before surgery. The results were retrospectively evaluated and compared to postoperative histopathological findings. 13 patients with PHPT were enrolled (mean age 64.3 years, preoperative calcium 2.74 mmol/l and parathyroid hormone 114.6 ng/l). FCH localized hyperfunctioning parathyroid glands in 12 patients of 13 (per patient sensitivity 92 % and positive predictive value (PPV) 100 %). Fourteen parathyroid lesions (11 adenomas, 3 hyperplastic glands) were resected with a mean size of 11.9 mm (per lesion sensitivity 93 % and PPV 81 %). Four adenomas and one hyperplastic gland were composed of only chief cells, whereas five lesions contained both chief and oxyphil cells. In three patients an exclusively oxyphil adenoma was found, surprisingly with negative MIBI scintigraphy in spite of a high mitochondria content in the oxyphil parathyroid cells. 12 of 13 patients had thyroid disease. In our limited study sample, FCH correctly identified parathyroid adenomas and/or hyperplastic glands in 92 % of patients with previously inconclusive conventional imaging. Unlike MIBI, FCH successfully localized small, hyperplastic and multiple hyperfunctioning parathyroid glands, irrespective of their histopathological composition.

scholarly journals F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study

2017 ◽  
Vol 45 (4) ◽  
pp. 658-666 ◽  
Author(s):  
Elske Quak ◽  
David Blanchard ◽  
Benjamin Houdu ◽  
Yannick Le Roux ◽  
Renaud Ciappuccini ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Ct Guided ◽  
Guided Surgery ◽  
Choline Pet ◽  
Pet Ct ◽  
Mibi Spect

scholarly journals Intra- and inter-observer agreement in the visual interpretation of interim 18F-FDG PET/CT in malignant lymphoma: influence of clinical information

2018 ◽  
Vol 59 (10) ◽  
pp. 1218-1224 ◽  
Author(s):  
Maya Kato Arimoto ◽  
Yuji Nakamoto ◽  
Tatsuya Higashi ◽  
Takayoshi Ishimori ◽  
Mana Ishibashi ◽  
...  
Keyword(s):  
Malignant Lymphoma ◽  
Clinical Information ◽  
Kappa Statistic ◽  
Visual Assessment ◽  
Observer Variation ◽  
Observer Agreement ◽  
Visual Interpretation ◽  
Interim Pet ◽  
Positron Emission ◽  
Pet Ct

Background Interim PET/CT is widely performed in lymphoma patients in clinical practice and clinical trials. Visual assessment using a 5-point scale is proposed for PET/CT interpretation, but intra- and inter-observer variation is not fully investigated. Purpose To investigate intra- and inter-observer variations in the reporting of interim positron emission tomography/computed tomography (PET/CT) in lymphoma patients, and the influence of clinical information on the interpretation. Material and Methods Three expert readers from different institutions interpreted interim PET/CT images of 42 consecutive patients with malignant lymphoma twice, with and without clinical information. The intra- and inter-observer agreements were calculated using the kappa statistic on a patient and a region basis. Results On a patient basis, intra-observer agreement, inter-observer agreement without information, and inter-observer agreement with information were within the ranges 0.48–0.62, 0.51–0.62, and 0.42–0.76, respectively. In the evaluation of lymph nodes, intra-observer agreement, inter-observer agreement without information, and inter-observer agreement with information were within the ranges 0.78–0.92, 0.80–0.82, and 0.77–0.83, respectively. Observer agreements were in almost perfect to substantial agreement categories for most lymphatic organs, but were generally low for the other organs. Conclusion The intra- and inter-observer agreements in evaluating interim PET/CT were relatively low for extranodal lesions, but they were substantial to almost perfect when interpreting nodal regions in malignant lymphoma, irrespective of the provision of clinical information, although memory at the first interpretation might have affected the intra-observer results.

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