18F-Fluorocholine PET and 4D-CT in Patients with Persistent and Recurrent Primary Hyperparathyroidism

Latgé, Adrien; Riehm, S.; Vix, Michel; Bani, Jacob; Ignat, Mihaela; Pretet, Valentin; Helali, M.; Treglia, Giorgio; Impériale, Alessio

doi:10.3390/diagnostics11122384

Cited by 15 publications

(7 citation statements)

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“…Hence, an upfront optimized imaging for the detection and precise localization of hyperfunctioning parathyroid glands remains crucial, as the first intervention is the best time to achieve patient cure. Despite the only limited data available regarding the role of 18 F-FCH PET/CT in the reoperative setting, 18 F-FCH PET/CT appears to be a valuable technique to accurately detect hyperfunctioning parathyroid tissue in patients with persistent/recurrent pHPT and is better than 4D-CT and 99m Tc-sestamibi scintigraphy ( 11 , 24 ). In our cohort, 18 F-FCH PET/CT revealed three hyperfunctioning parathyroid hyperplasia undetected by scintigraphy in two patients with recurrent pHPT.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, positron emission tomography/computed tomography/computed tomography (PET/CT) with 18 F-fluorocholine ( 18 F-FCH) has emerged as second-line imaging with high resolution, low radiation exposure, and shorter examination times in patients with previously negative or inconclusive 99m Tc-sestamibi scintigraphy and/or ultrasound ( 9 ). A growing body of evidence suggests the high sensitivity of 18 F-FCH PET/CT in detecting hyperfunctioning parathyroids (sensitivity and detection rate up to 90 and 80%, respectively) in patients with pHPT ( 10 ), even in reoperated patients ( 11 ). Recently published parathyroid imaging guidelines suggest, when possible, 18 F-FCH PET/CT as a potential “alternative” first-line option in patients with pHPT ( 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?

et al. 2023

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IntroductionTo investigate the value of presurgical 18F-FCH PET/CT in detecting additional hyperfunctioning parathyroids despite a positive 99mTc-sestamibi parathyroid scintigraphy in patients with primary hyperparathyroidism (pHPT).MethodsThis is a retrospective study involving patients with pHPT, positive parathyroid scintigraphy performed before 18F-FCH PET/CT, and parathyroid surgery achieved after PET/CT. Imaging procedures were performed according to the EANM practice guidelines. Images were qualitatively interpreted as positive or negative. The number of pathological findings, their topography, and ectopic location were recorded. Histopathology, Miami criterion, and biological follow-up were considered to ensure effective parathyroidectomy confirming the complete excision of all hyperfunctioning glands. The impact of 18F-FCH PET/CT on therapeutic strategy was recorded.Results64/632 scanned pHPT patients (10%) were included in the analysis. According to a per lesion-based analysis, sensitivity, specificity, positive predictive value, and negative predictive value of 99mTc-sestamibi scintigraphy were 82, 95, 87, and 93%, respectively. The same values for 18F-FCH PET/CT were 93, 99, 99, and 97%, respectively. 18F-FCH PET/CT showed a significantly higher global accuracy than 99mTc-sestamibi scintigraphy: 98% (CI: 95–99) vs. 91% (CI: 87–94%). Youden Index was 0.79 and 0.92 for 99mTc-sestamibi scintigraphy and 18F-FCH PET/CT, respectively. Scintigraphy and PET/CT were discordant in 13/64 (20%) patients (49 glands). 18F-FCH PET/CT identified nine pathologic parathyroids not detected by 99mTc-sestamibi scintigraphy in 8 patients (12.5%). Moreover, 18F-FCH PET/CT allowed the reconsideration of false-positive scintigraphic diagnosis (scinti+/PET-) for 8 parathyroids in 7 patients (11%). The 18F-FCH PET/CT influenced the surgical strategy in 7 cases (11% of the study population).ConclusionIn a preoperative setting, 18F-FCH PET/CT seems more accurate and useful than 99mTc-sestamibi scan in pHPT patients with positive scintigraphic results. Positive parathyroid scintigraphy could be not satisfactory before neck surgery particularly in patients with multiglandular disease, suggesting a need to evolve the practice and define new preoperative imaging algorithms including 18F-FCH PET/CT at the fore-front in pHPT patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?

et al. 2023

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“…Several studies have proposed preoperative localization procedures that are more sensitive to detect multiglandular disease, small lesions, or possible ectopic parathyroid tissue in MEN1-related PHPT, such as 18F-fluorocholine PET/CT (FCH-PET/CT), with or without enhanced arterial imaging, and four-dimensional computed tomography (4D-CT), especially when conventional preoperative imaging before the first intervention is inconclusive [ 19 , 20 , 21 , 22 ]. In particular, the performance of 18F-FCH-PET/CT in PHPT appears to be superior compared to commonly used imaging using 99m Tc-sestamibi scintigraphy, ultrasound, and 4D-CT [ 21 , 23 , 24 , 25 , 26 ], and provides valuable information even in cases with recurrent disease and negative or equivocal 99m Tc-sestamibi scintigraphy and/or ultrasound.…”

Section: Discussionmentioning

confidence: 99%

Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience

Yavropoulou

Vlachou

Tsoli

et al. 2022

JCM

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Background: Primary hyperparathyroidism (PHPT) in the most common and earliest manifestation of multiple endocrine neoplasia type-1 (MEN1). Epidemiological data have been reported in MEN1 patients but data on long-term follow-up focusing on PHPT are scarce. Methods: In this retrospective cohort study, we included patients diagnosed with MEN1-related PHPT that were under regular follow-up in our institution. Results: Data on 68 patients (39 males), with a mean age at MEN1-diagnosis of 39 ± 13.06 years, were analyzed. Pancreatic neuroendocrine tumors were encountered in 82% (71% nonsecreting) followed by pituitary adenomas in 66% (49% nonsecreting). Mean age at PHPT diagnosis was 35.2 ± 4.0 years. Parathyroidectomy was performed in 57 patients (82.3%), of whom 56% achieved long-term remission, while 12.2% and 31.5% had persistent and recurrent disease, respectively (median follow-up of 4 years; range 1–21 years). Cinacalcet restored serum calcium levels in 33.8%, both as first and as a second line treatment. Permanent hypoparathyroidism occurred in 19.2%. MEN1 pathogenic variants were identified in 77.2% of the tested individuals, but no genotype-phenotype associations were reported. Conclusions: MEN1-related PHPT involves a multiglandular disease and its management remains a therapeutic challenge, as recurrent disease can develop even after 20 years of follow-up. Prolonged follow-up of these patients at referral centers is critical for their optimal management.

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“…Latge et al [ 115 ] investigated the efficacy of FCH-PET/CT and 4D-CT in 43 patients with perHPT and recHPT, finding the sensitivity as 95% and 70%, detection rate as 88% and 63%, respectively, and FCH-PET/CT was found to be superior. There was no increase in sensitivity and detection rate when the two techniques were combined.…”

Section: Positron Emission Tomography (Pet) and Pet/ctmentioning

confidence: 99%

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

Uludağ¹

2023

Sisli Etfal

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Primary hyperparathyroidism (pHPT) is the most common cause of hypercalcemia and currently the only definitive treatment is surgery. Although the success rate of parathyroidectomy is over 95% in experienced centers, surgical failure is the most common complication today. Persistent HPT (perHPT) is defined as persistence of hypercalcemia after parathyroidectomy or recurrence of hypercalcemia within the first 6 months, and recurrence of hypercalcemia after a normocalcemic period of more than 6 months is defined as recurrent HPT (recHPT). In the literature, perHPT is reported to be 2–22%, and the rate of recHPT is 1–15%. perHPT is often associated with misdiagnosed pathology or inadequate resection of hyperfunctioning parathyroid tissue, recHPT is associated with newly developing pathology from potentially pathologically natural tissue left in situ at the initial surgery. In the pre-operative evaluation, the initial diagnosis of pHPT and the diagnosis of perHPT or rec HPT should be confirmed in patients who are evaluated with a pre-diagnosis (suspect) of perHPT and recHPT. Surgery is recommended if it meets any of the recommendations in surgical guidelines, as in patients with pHPT, and there are no surgical contraindications. The first preoperative localization studies, surgical notes, operation drawings, if any, intraoperative PTH results, pathological results, and post-operative biochemical results of these patients should be examined. Localization studies with preoperative imaging methods should be performed in all patients with perHPT and recHPT with a confirmed diagnosis and surgical indication. The first-stage imaging methods are ultrasonography and Tc99m sestamibi single photon tomography Tc99mMIBI SPECT or hybrid imaging method, which is combined with both single-photon emission computed tomography and computed tomography (SPECT/CT). The combination of USG and sestamibi scintigraphy increases the localization of the pathological gland. In the secondary stage, Four-Dimensional computer tomography (4D-CT) or dynamic 4-dimensional Magnetic Resonance Imaging (4D-MRI) can be applied. It is focused on as a secondary stage imaging method, especially when the lesion cannot be detected by conventional methods. Positron Emission Tomography (PET) and PET/CT examinations with 11C-choline or 18F-fluorocholine are promising imaging modalities. Invasive examinations can rarely be performed in patients in whom suspicious, incompatible or pathological lesion cannot be detected in noninvasive imaging methods. Bilateral jugular vein sampling, selective venous sampling, parathyroid arteriography, imaging-guided fine-needle aspiration biopsy, and parathormone washout are invasive methods.

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18F-Fluorocholine PET and 4D-CT in Patients with Persistent and Recurrent Primary Hyperparathyroidism

Cited by 15 publications

References 32 publications

Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?

Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?

Management and Long-Term Follow-Up of Hyperparathyroidism in Multiple Endocrine Neoplasia Type 1: Single Center Experience

Persistent and Recurrent Primary Hyperparathyroidism: Etiological Factors and Preoperative Evaluation

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