11C-methionine PET/CT after in conclusive 99mTc-MIBI-SPECT/CT for localisation of parathyroid adenomas in primary hyperparathyroidism

Braeuning, U.; Pfannenberg, Christina; Gallwitz, Baptist; Teichmann, R.; Mueller, Mark; Dittmann, Helmut; Reimold, Matthias; Bares, Roland

doi:10.3413/nukmed-0686-14-07

Cited by 20 publications

(31 citation statements)

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“…In previous studies, 11 C-methionine has been shown to be of great value, especially, but not only, in the setting of negative 99m Tc-sestamibi results (14)(15)(16)(17). The pooled sensitivity in a metaanalysis of 9 studies with a total of 137 patients was found to be 86% (24).…”

Section: Discussionmentioning

confidence: 92%

“…Therefore, problems arise if neither imaging modality can locate the PTA or if the results obtained by imaging are inconclusive or discordant. 11 C-methionine PET/CT has been successfully applied in this setting (14)(15)(16)(17)(18). During the last few years, radiolabeled choline has been increasingly used to localize PTAs, with high sensitivities reported (19)(20)(21)(22).…”

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confidence: 99%

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Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

et al. 2019

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We aimed to assess the value of 11 C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99m Tc-sestamibi imaging and neck ultrasound. Methods: Eightyseven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUV max and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11 C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had falsepositive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUV max was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11 C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99m Tc-sestamibi imaging yield negative or discordant results.

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Section: Discussionmentioning

confidence: 92%

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confidence: 99%

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

et al. 2019

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“…After full text review, 24 papers were included. These were subdivided by radiopharmaceutical: 14 studies investigated 11C-MET, one [ 11 C]2-hydroxy- N , N , N -trimethylethanamium (11C-CH), six 18F-FDG, one 6-[ 18 F] fluoro- l -DOPA (18F-DOPA), and three N -[( 18 F)Fluoromethyl]-2-hydroxy- N , N -dimethylethanaminium (18F-FCH) [13–36]. Excluded were studies that had fewer than five patients, abstracts from conferences without available full text, and redundant studies investigating the same population.…”

Section: Resultsmentioning

confidence: 99%

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Kluijfhout

Pasternak

Drake

et al. 2016

Langenbecks Arch Surg

104

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Purpose The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers. Methods A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance. Conclusions The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPVand may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.

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“…In Beggs et al, also patients in whom other imaging techniques such as MIBI scanning, CT, or ultrasound had earlier failed to localize the adenoma were selected. In a recent smaller study with 18 patients, Braeuning et al found a sensitivity per patient of 91.7% and a sensitivity per lesion of 73.3% after a prior negative 99m Tc-MIBI-SPECT/CT [ 24 ]. Another smaller study by Chun et al who included 16 patients found a sensitivity of 91.7%, but did not select patients with prior negative imaging [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

Noltes

Coester

Horst-Schrivers

et al. 2017

Langenbecks Arch Surg

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PurposeMinimally invasive parathyroidectomy (MIP) is the recommended treatment in primary hyperparathyroidism (pHPT) for which accurate preoperative localization is essential. The current imaging standard consists of cervical ultrasonography (cUS) and MIBI-SPECT/CT. 11C-MET PET/CT has a higher resolution than MIBI-SPECT/CT. The aim of this study was to determine the diagnostic performance of 11C-MET PET/CT after initial inconclusive or negative localization.MethodsWe performed a retrospective single center cohort study of patients with pHPT undergoing parathyroid surgery after prior negative imaging and later localization by means of 11C-MET PET/CT between 2006 and 2014. Preoperative localization by 11C-MET PET/CT was compared with later surgical localization, intraoperative quick PTH (IOPTH), duration of surgery, histopathology, and follow-up data. Also, differences in duration of surgery between the groups with and without correct preoperative localization were analyzed.ResultsIn 18/28 included patients a positive 11C-MET-PET/CT result corresponded to the surgical localized adenoma (64%). In 3/28 patients imaging was false positive and no adenoma was found. In 7/28 patients imaging was false negative at the side of the surgically identified adenoma. Sensitivity of 11C-MET PET/CT was 72% (18/25). Duration of surgery of correctly localized patients was significantly shorter compared to falsely negative localized patients (p = 0.045).ConclusionIn an intention to treat 11C-MET-PET/CT correctly localized the parathyroid adenoma in 18/28 (64%) patients, after previous negative imaging. A preoperatively correct localized adenoma leads to a more focused surgical approach (MIP) potentially reducing duration of surgery and potentially healthcare costs.

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11C-methionine PET/CT after in conclusive 99mTc-MIBI-SPECT/CT for localisation of parathyroid adenomas in primary hyperparathyroidism

Abstract: PET/CT with 11C-methionine is a very sensitive method for the detection of parathyroid adenomas, even if they are too small to be visualized by 99mTc-MIBI-SPECT/CT.

Cited by 20 publications

References 9 publications

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

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11C-methionine PET/CT after in conclusive 99mTc-MIBI-SPECT/CT for localisation of parathyroid adenomas in primary hyperparathyroidism

Abstract: PET/CT with 11C-methionine is a very sensitive method for the detection of parathyroid adenomas, even if they are too small to be visualized by 99mTc-MIBI-SPECT/CT.

Cited by 20 publications

References 9 publications

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis

Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging

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Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT