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

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.

scholarly journals Upfront F18-choline PET/CT versus Tc99m-sestaMIBI SPECT/CT guided surgery in primary hyperparathyroidism: the randomized phase III diagnostic trial APACH2

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elske Quak ◽  
Audrey Lasne Cardon ◽  
Renaud Ciappuccini ◽  
Charline Lasnon ◽  
Vianney Bastit ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Patient Care ◽  
Phase Iii ◽  
Imaging Method ◽  
Complication Rates ◽  
First Line ◽  
Ct Guided ◽  
Pet Ct ◽  
Line Imaging ◽  
Mibi Spect

Abstract Background The common endocrine disorder primary hyperparathyroidism (PHPT) can be cured by surgery. Preoperative localization of parathyroid adenoma (PTA) by imaging is a prerequisite for outpatient minimally invasive parathyroidectomy (MIP). Compared to inpatient bilateral cervical exploration (BCE) which is performed if imaging is inconclusive, MIP is superior in terms of cure and complication rates and less costly. The imaging procedure F18-choline (FCH) PET/CT outperforms Tc99m-sestaMIBI (MIBI) SPECT/CT for PTA localization, but it is much costlier. The aim of this study is to identify the most efficient first-line imaging modality for optimal patient care in PHPT without added cost to society. Methods We will conduct a multicenter open diagnostic intervention randomized phase III trial comparing two diagnostic strategies in patients with PHPT: upfront FCH PET/CT versus MIBI SPECT/CT. The primary endpoint is the proportion of patients in whom the first-line imaging method results in successful MIP and cure. Follow-up including biological tests will be performed 1 and 6 months after surgery. The main secondary endpoint is the social cost of both strategies. Other secondary endpoints are as follows: FCH PET/CT and MIBI SPECT/CT diagnostic performance, performance of surgical procedure and complication rate, FCH PET/CT inter- and intra-observer variability and optimization of FCH PET/CT procedure. Fifty-eight patients will be enrolled and randomized 1:1. Discussion FCH PET/CT is a highly efficient but expensive imaging test for preoperative PTA localization and costs three to four times more than MIBI SPECT/CT. Whether FCH PET/CT improves patient outcomes compared to the reference standard MIBI SPECT/CT is unknown. To justify its added cost, FCH PET/CT-guided parathyroid surgery should lead to improved patient management, resulting in higher cure rates and fewer BCEs and surgical complications. In the previous phase II APACH1 study, we showed that second-line FCH PET/CT led to a cure in 88% of patients with negative or inconclusive MIBI SPECT/CT. BCE could be avoided in 75% of patients and surgical complication rates were low. We therefore hypothesize that upfront FCH PET/CT would improve patient care in PHPT and that the reduction in clinical costs would offset the increase in imaging costs. Trial registration NCT04040946, registered August 1, 2019.  Protocol version Version 2.1 dated from 2020/04/23.

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 Diagnostic value of four-dimensional computed tomography and four-dimensional magnetic resonance imaging in primary hyperparathyroidism when first-line imaging was inadequate

2020 ◽  
Vol 102 (4) ◽  
pp. 294-299
Author(s):  
N Acar ◽  
M Haciyanli ◽  
M Coskun ◽  
NK Erdogan ◽  
SC Celik ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Primary Hyperparathyroidism ◽  
Dynamic Imaging ◽  
Successful Outcome ◽  
Preoperative Imaging ◽  
Resonance Imaging ◽  
First Line ◽  
Line Imaging

Introduction Accurate localisation of the abnormal hyperfunctioning gland with preoperative imaging has a critical role in parathyroid surgery to obtain a successful outcome. This study aimed to evaluate the diagnostic performance of second-line imaging and their contribution to the treatment success in primary hyperparathyroidism when the first-line methods were negative or discordant. Methods Among the patients who underwent parathyroidectomy due to primary hyperparathyroidism, 33 who underwent four-dimensional computed tomography and/or four-dimensional magnetic resonance imaging because of negative or discordant first-line imaging results were included. Persistent and recurrent cases were excluded. Results The majority of the patients were female (84.8%) and the mean age was 59.2 years. Seventeen patients had four-dimensional computed tomography and 25 had four-dimensional magnetic resonance imaging, respectively. Four-dimensional computed tomography and four-dimensional magnetic resonance imaging localised the culprit gland successfully in 52.9% and 84%, respectively. Twenty-five patients in whom single adenoma was detected underwent focused parathyroidectomy. The culprit gland was solitary in 32 cases and one patient had double adenoma. Normocalcaemia was achieved in all cases. Among the 29 patients who completed their postoperative sixth month success rate was 100%. Conclusion Four-dimensional magnetic resonance imaging had high accuracy with fast dynamic imaging in detecting parathyroid adenomas. When the first-line imaging methods were negative or inconclusive, four-dimensional magnetic resonance imaging should be considered primarily since it is cost effective in Turkey and emits no radiation.

The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism

HORMONES ◽  
2020 ◽  
Author(s):  
Mechteld C. de Jong ◽  
K. Jamal ◽  
S. Morley ◽  
T. Beale ◽  
T. Chung ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Primary Hyperparathyroidism ◽  
Imaging Modality ◽  
First Line ◽  
Line Imaging

A randomized trial comparing fluorocholine-PET/CT with conventional imaging in prostate cancer.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 2-2
Author(s):  
Scott Williams ◽  
Jean-Mathieu Beauregard ◽  
Peter Roselt ◽  
Kate Moody ◽  
Richard Fisher ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Progressive Disease ◽  
Randomised Trial ◽  
Whole Body ◽  
Conventional Imaging ◽  
Newly Diagnosed ◽  
First Line ◽  
Pet Ct ◽  
Significant Difference ◽  
Line Imaging

2 Background: We conducted a randomised trial comparing 18Flourocholine-PET/CT (FCH) to Computed Tomography (abdomen and pelvis) plus 99mTc-Whole Body Bone Scan (Conventional Imaging [CIm]) to determine imaging performance in prostate cancer (PC). Methods: This prospective two-arm 1:1 randomised trial enrolled men with newly diagnosed or biochemically recurrent PC to first-line imaging (FLI) with either CIm or FCH. Participants without evidence of metastases proceeded to second-line imaging (SLI) using the alternative imaging strategy. The primary aim was to determine whether FCH was more effective as a FLI approach in changing management. Secondary endpoints included incremental utility of SLI and negative predictive value (NPV) based on progression-free survival (PFS). Australian New Zealand Clinical Trials Registry ACTRN12608000641392. Results: 108 men were enrolled; 44% were for staging of newly-diagnosed PC and median follow-up 43 months. Imaging impacted clinical management in 32.4% of men (95% CI=23.7-42.1%), mostly with FLI (n=30). High-impact management changes occurred in 27.8% (95% CI=16.5-41.6%) of FCH cases compared with 11.1% (95% CI=4.2-22.6%) in the CIm arm (p=0.032). The final management plan was derived using FCH in 98.1% (95% CI = 90.1-100%) of cases and 92.6% (95%CI = 82.1-97.9%) of CIm cases (p=0.242). FLI with FCH showed unequivocally N1 or M1 disease in 22.2% (95% CI = 12-35.6%), and 16.7% (95% CI = 7.9-29.3%; p= 0.531) of CIm cases. The overall NPV for stage TxN0M0 (from all imaging) was 26.3% (95% CI: 13.9 - 41.2%), with no significant difference between arms (p=0.9). For N1M0 cases, the NPV was 14.3% (95% CI: 7.1 - 35.7%). The identification of N1M0 by FCH resulted in a longer time to identification of progressive disease, with a median PFS of 32 months (95% CI=2-68months) compared with 3 months (95% CI=1-16 months) in the CIm N1M0 cohort (p=0.05). Conclusions: FCH-PET/CT identifies more high-clinical-impact lesions than CIm as first-line imaging. All imaging modalities were poor at predicting subsequent progressive disease. Isolated node-positive disease seen with FCH is associated with a longer time to - but similarly high rates of - recurrence, suggesting a lead-time bias. Clinical trial information: ACTRN12608000641392.

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
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