18F-Fluorocholine PET/CT in Primary Hyperparathyroidism: Superior Diagnostic Performance to Conventional Scintigraphic Imaging for Localization of Hyperfunctioning Parathyroid Glands

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.

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

Physiological Research ◽

10.33549/physiolres.934029 ◽

2018 ◽

pp. S551-S557 ◽

Cited By ~ 7

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.

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Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-Fluorocholine PET/CT

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-018-4018-z ◽

2018 ◽

Vol 45 (10) ◽

pp. 1772-1780 ◽

Cited By ~ 24

Author(s):

Serena Grimaldi ◽

Jacques Young ◽

Peter Kamenicky ◽

Dana Hartl ◽

Marie Terroir ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

Parathyroid Glands ◽

Added Value ◽

Pet Ct

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

European Journal of Hybrid Imaging ◽

10.1186/s41824-021-00108-z ◽

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).

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

Endocrine Abstracts ◽

10.1530/endoabs.70.aep207 ◽

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

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Diagnostic performance of 18F-FDG PET/CT, ultrasonography and MRI

Nuklearmedizin ◽

10.3413/nukmed-0605-13-06 ◽

2014 ◽

Vol 53 (03) ◽

pp. 89-94 ◽

Cited By ~ 17

Author(s):

D. H. Lee ◽

J.-K Yoon ◽

S. J. Lee ◽

T. H. Kim ◽

D. K. Kang ◽

...

Keyword(s):

Lymph Node ◽

Fdg Pet ◽

Axillary Lymph Node ◽

Diagnostic Performance ◽

Axillary Lymph ◽

Diagnostic Ability ◽

Node Metastasis ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

SummaryThe aim of this study was to evaluate the diagnostic abilities of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) compared with those of ultrasonography and magnetic resonance imaging (MRI) for axillary lymph node staging in breast cancer patients. Patients, methods: Pre- operative 18F-FDG PET/non-contrast CT, ultrasonography and MRI were performed in 215 women with breast cancer. Axillary lymph node dissection was performed in all patients and the diagnostic performance of each modality was evaluated using histopathologic assessments as the reference standard. ROC curves were compared to evaluate the diagnostic ability of several imaging modalities (i. e., ultrasonography, MRI and 18F-FDG PET/CT). Results: In total, 132 patients (61.4%) had axillary lymph node metastasis. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the detection of axillary lymph node metastasis were 72.3%, 77.3%, 66.7%, 81.6%, 75.3% for ultrasonography, 67.5%, 78.0%, 65.9%, 79.2%, 74.0% for MRI, and 62.7%, 88.6%, 77.6%, 79.1%, 78.6% for 18F-FDG PET/CT, respectively. There was no significant difference in diagnostic ability among the imaging modalities (i.e., ultrasonography, MRI and 18F-FDG PET/CT). The diagnostic ability of 18F-FDG PET/CT was significantly improved by combination with MRI (p = 0.0002) or ultrasonography (p < 0.0001). The combination of 18F-FDG PET/CT with ultrasonography had a similar diagnostic ability to that of all three modalities combined (18F-FDG PET/CT+ultraso- nography+MRI, p = 0.05). Conclusion: The diagnostic performance of 18F-FDG PET/CT for detection of axillary node metastasis was not significantly different from that of ultrasonography or MRI in breast cancer patients. Combining 18F-FDG PET/CT with ultrasonography or MRI could improve the diagnostic performance compared to 18F-FDG PET/CT alone.

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Parathyroid glands in primary hyperparathyroidism: An ultrastructural study of 50 cases

Human Pathology ◽

10.1016/s0046-8177(86)80088-0 ◽

1986 ◽

Vol 17 (10) ◽

pp. 1036-1046 ◽

Cited By ~ 10

Author(s):

Saverio Cinti ◽

Giacomo Colussi ◽

Ernesto Minola ◽

G. Richard Dickersin

Keyword(s):

Primary Hyperparathyroidism ◽

Ultrastructural Study ◽

Parathyroid Glands

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Advances in the diagnosis and the management of primary hyperparathyroidism

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211015965 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110159

Author(s):

Ana Kashfia Islam

Keyword(s):

Renal Function ◽

Parathyroid Hormone ◽

Bone Loss ◽

Primary Hyperparathyroidism ◽

Kidney Stones ◽

Parathyroid Glands ◽

Definitive Treatment ◽

Indications For Surgery ◽

Musculoskeletal Complaints ◽

Parathyroid Cancer

The parathyroid glands, one of the last organs to be discovered, are responsible for maintaining calcium homeostasis, and they continue to present the clinician with diagnostic and management challenges that are reviewed herein. Primary hyperparathyroidism (PHPT) comprises the vast majority of pathology of the parathyroid glands. The classic variant, presenting with elevated calcium and parathyroid hormone levels, has been studied extensively, but the current body of literature has added to our understanding of normocalcemic and normohormonal variants of PHPT, as well as syndromic forms of PHPT. All variants can lead to bone loss, kidney stones, declining renal function, and a variety of neurocognitive, gastrointestinal, and musculoskeletal complaints, although the majority of PHPT today is asymptomatic. Surgery remains the definitive treatment for PHPT, and advances in screening, evolving indications for surgery, new imaging modalities, and improvements in intra-operative methods have greatly changed the landscape. Surgery continues to produce excellent results in the hands of an experienced parathyroid surgeon. For those patients who are not candidates for surgery, therapeutic advances in medical management allow for improved control of the hypercalcemic state. Parathyroid cancer is extremely rare; the diagnosis is often made intra-operatively or on final pathology, and recurrence is common. The mainstay of treatment is normalization of serum calcium via surgery and medical adjuncts.

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