18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature

Evangelista, Laura; Ravelli, Ilaria; Magnani, F; Iacobone, Maurizio; Giraudo, Chiara; Camozzi, Valentina; Spimpolo, Alessandro; Cecchin, Diego

doi:10.1007/s12149-020-01507-1

Cited by 45 publications

(96 citation statements)

References 47 publications

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“…The sensitivity of 11 C-methionine PET/CT is reported 72-86% [6,7,11,12], whereas in 18 F-fluorocholine PET/ CT sensitivity is 90-96% [8][9][10][13][14][15]. Studies regarding the diagnostic performance of 11 C-choline PET/CT are however scarce.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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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Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…The results of choline PET in combination with magnetic resonance (MR) imaging are promising (90% sensitivity, 100% PPV in the Kluijfhout et al study [24]) but more research and a larger sample size are needed [28,35,50].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

et al. 2021

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Hyperparathyroidism is a metabolic disorder characterized by the excessive production of the parathyroid hormone. The diagnosis is based on clinical and laboratory data. In most cases the only treatment is surgery and a correct preoperatory localization of the hyperfunctioning parathyroid gland(s) is essential. Currently, ultrasonography combined with [99mTc]Tc-MIBI parathyroid scintigraphy, optionally associated with single photon emission computed tomography/computed tomography (SPECT/CT), represent the standard preoperative imaging. In recent years, a number of studies have evaluated the potential role of choline positron emission tomography (PET) in hyperparathyroidism with promising results. Most of the recent evidence underlined its higher sensitivity and diagnostic accuracy in the localization of hyperfunctioning parathyroid glands. Choline PET has a higher spatial resolution that is useful for the detection of smaller parathyroid glands and it also has shorter examination times and favorable radiation exposure. These are just a few of the aspects that support it to overcome traditional imaging. Moreover, from the preliminary data, the choline uptake mechanism seems to also have an impact on its better performance. For these reasons, if first used as second level imaging in patients with negative or inconclusive traditional imaging results, several authors have supported its use as a first line investigation. This comprehensive overview aims to provide an accurate description of the preliminary results available in the literature about the use of choline PET/CT in hyperparathyroidism and to compare these results with the performance of traditional imaging methods.

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“…A recent systematic review (23 articles, 1112 patients) compared FCH-PET/CT with conventional morphological and functional imaging in patients with biochemical hyperparathyroidism and found that FCH-PET/CT sensitivity ranged from 58 %-100 % which may be related to type of conventional imaging, patient population, and FCH-PET/CT protocol [ 18 ]. More recent studies found FCH-PET/CT sensitivity of 91 % (84/92 lesions) when defining lesions with both positive and inconclusive FCH uptakes as positive [ 19 ], 94 % in 101 patients with PTH-dependent hypercalcemia and negative or discordant conventional imaging (vs. 45 % and 44 % for MIBI scan and US, respectively) [ 20 ], 92 % in 103 patients (vs. 39–56 % for conventional scintigraphy) [ 21 ], and 62 % 47 patients after inconclusive first line imaging including US and subtraction scan [ 22 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…In addition, FCH-PET/CT specificity is not well known. The 2018 meta-analysis by Kim et al showed a pooled specificity of 94 % [ 15 ] and in the recent systematic review by Evangelista et al, specificity ranged from 12.5 % (per lesion) to 100 % [ 18 ]. More recent studies showed a false positive rate of 8.7 % in 84 patients when defining lesions with both positive and inconclusive uptake as positive [ 19 ], 1 % in 103 patients [ 21 ], and 2 % in 105 patients [ 20 ].…”

Section: Case Presentationmentioning

confidence: 99%

“…Recently, 18 F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) has shown superior sensitivity in localizing parathyroid adenomas than conventional morphological and functional imaging [ 15 – 18 ]. FCH-PET/CT has been recommended when conventional imaging is negative or discordant [ 19 – 24 ] and also as first line imaging [ 25 ].…”

Section: Introductionmentioning

confidence: 99%

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Misleading localization by 18F-fluorocholine PET/CT in familial hypocalciuric hypercalcemia type-3: a case report

et al. 2021

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Background Familial hypocalciuric hypercalcemia (FHH) is a heterogeneous autosomal-dominant disorder of calcium hemostasis that may be difficult to distinguish clinically from mild primary hyperparathyroidism. Loss-of-function mutations mainly involving Arg15 residue of the adaptor-related protein complex 2, sigma subunit 1 (AP2S1) cause a rarer, more recently recognized form of FHH, FFH type-3. Recently, 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) showed superior sensitivity to conventional imaging in localizing parathyroid adenomas. We report a new FFH type-3 patient who underwent unnecessary parathyroidectomy in association with misleading FCH-PET/CT imaging. Case presentation A 29-year old woman was initially evaluated for parathyroid hormone (PTH)-dependent hypercalcemia in 2013. Medical history was positive only for chronic constipation and malaise with no personal or family history of hypercalcemia, kidney stones, or neck surgery. Over seven years, serum calcium level was 2.51–2.89 mmol/L with concomitant PTH level of 58.7–94.8 mmol/L. Serum phosphate levels were in the low/low normal range. Serum creatinine and magnesium levels were normal. 25-hydroxy vitamin D level was 13 nmol/L. 24-hour urine calcium level was 1.92 mmol/day but increased to 6.99 mmol/day after treatment with cholecalciferol 1000 IU daily. Bone mineral density and renal ultrasound were normal. Parathyroid ultrasound showed two hypoechoic nodules inferior to the left and right thyroid lobes; however, 99mtechnitium-sestamibi scans (2013, 2016, 2018) were negative. FCH-PET/CT (2019) showed focal uptake co-localizing with the nodule inferior to the left thyroid lobe. The patient underwent left inferior parathyroidectomy and pathology was consistent with parathyroid hyperplasia. However, postoperatively, serum calcium and PTH levels remained elevated and FCH-PET/CT and ultrasound showed persistence of the uptake/nodule. Whole exome sequencing showed Arg15Cys mutation in the AP2S1 gene characteristic of FHH type-3. Conclusions In this new case of FHH type-3, FCH-PET/CT failed to localize to the hyperplastic parathyroid glands and localized instead to apparently a lymph node. This, together with increased urinary calcium after vitamin D supplementation, led to unnecessary parathyroidectomy. Given the increasingly lower cost of genetic testing and the cost of follow up and unnecessary surgery, it may prudent to include genetic testing for FHH early on in patients with mild PTH-dependent hypercalcemia.

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18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature

Cited by 45 publications

References 47 publications

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

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

Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

Misleading localization by 18F-fluorocholine PET/CT in familial hypocalciuric hypercalcemia type-3: a case report

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