Accurate pre‐operative localization of pathological parathyroid glands using <sup>11</sup>C‐methionine PET/CT

Tang, Bich-Ngoc-Thanh; Moreno‐Reyes, Rodrigo; Blocklet, Didier; Corvilain, Bernard; Cappello, Mattéo; Delpierre, Isabelle; Simaeys, Gaëtan Van; Goldman, Serge

doi:10.1002/cmmi.243

Cited by 50 publications

(33 citation statements)

References 25 publications

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“…Our results were generally agreed with the previous reports [9,10,[16][17][18] and showed even higher performance compared with the results of meta-analysis reported by Caldarella et al [21]. In quantitative analysis, SUVR showed correlation with sPTH level in patients with PA.…”

Section: Discussionsupporting

confidence: 93%

“…11 C-Methionine positron emission tomography/computed tomography (Met-PET/CT) has been increasingly used in oncologic imaging as a complementary method to 18 F-FDG PET/CT that is limited in the differentiation of a malignant lesion from coexisting peritumoral or post-therapeutic inflammatory change [11][12][13]. In particular, it has been known that methionine is one of amino acids comprising parathyroid hormone and that it is closely related with biosynthesis of parathyroid hormone [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, Met-PET/CT was introduced and expected to have high detection performance of parathyroid tissues due to specific accumulation of 11 C-methionine and high resolution of PET/CT. However, it has been reported that sensitivity of Met-PET/CT in detection of PA is variably 44-90 % [16][17][18][19][20]. Especially, a recent meta-analysis revealed that detection sensitivity and detection rate of Met-PET/CT were 0.81 and 0.70, respectively [18].…”

Section: Introductionmentioning

confidence: 99%

“…However, it has been reported that sensitivity of Met-PET/CT in detection of PA is variably 44-90 % [16][17][18][19][20]. Especially, a recent meta-analysis revealed that detection sensitivity and detection rate of Met-PET/CT were 0.81 and 0.70, respectively [18]. As Met-PET/CT being more frequently used, it is necessary to compare detection rate between Met-PET/CT and conventional MIBI scintigraphy to verify their clinical feasibility for surgical treatment.…”

Section: Introductionmentioning

confidence: 99%

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Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

Chun

Cheon

Paeng

et al. 2013

Nucl Med Mol Imaging

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Purpose 11 C-Methionine PET/CT (Met-PET/CT) is a useful imaging method for detection of parathyroid adenoma; however, the reported detection rate has been variable. The current study was intended to investigate detection sensitivity and preoperative localization of parathyroid adenoma (PA) or parathyroid hyperplasia (PH) on Met-PET/CT compared with Tc-sestamibi (MIBI) scintigraphy in patients with primary hyperparathyroidism (HPT) or suspected PA. Methods Met-PET/CT and MIBI scintigraphy images were reviewed by two nuclear medicine physicians unaware of pathologic results. Detection sensitivities and preoperative localization of detected parathyroid tissues into five predefined segments were evaluated by visual assessment and semiquantitative analysis with ratio of standardized uptake values (SUVR) between parathyroid tissue and normal lung as reference. Linear regression analysis with SUVR and serum parathyroid hormone (sPTH) was performed for characterization of PA or PH. Predicted PTH (pPTH) was calculated and compared with sPTH in PH and PA. Each pPTH was obtained for a calculated SUVR by using linear regression model from the result of previous linear regression analysis between SUVR and sPTH. Results In 16 patients, detection sensitivities of Met-PET/CT and MIBI scintigraphy were 91.7 % (11/12) and 41.7 % (5/12) for PA and PH including both biopsy-confirmed and clinicallysuspected cases, and 100 % (8/8) and 50 % (4/8) for pathologically confirmed PA and PH cases only, respectively. Met-PET/CT showed higher performance than MIBI scintigraphy in localization of parathyroid tissues; correct localization rate was 87.5 % (7/8) on Met-PET/CT and 50 % (4/8) on MIBI scintigraphy. In semi-quantitative analysis, SUVR was linearly associated with sPTH by linear regression analysis (sPTH=39.53×SUVR−89.84, p=0.0383). There was a borderline significant difference in pPTH between PH and PA (35.1 vs 204.7±164.0, p=0.052), while there was no significant difference in sPTH between PH and PA (289 vs 230.4±160.4, p=0.305). Conclusions Met-PET/CT has a potential to be a useful diagnostic modality for preoperative detection and localization of parathyroid tissues with higher sensitivity than MIBI scintigraphy, and for characterization of PA or PH.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

Chun

Cheon

Paeng

et al. 2013

Nucl Med Mol Imaging

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“…However, data on the performance of 11 C-methionine PET/CT in the reoperative setting of primary hyperparathyroidism are scarce. Tang et al reported high sensitivities of 95% for 99m Tc-sestamibi and 92% for 11 C-methionine PET/CT for parathyroid adenomas and 59% versus 68% for hyperplasia, respectively, before initial surgery of hyperparathyroidism (32). In line with this, the accuracy of 123 I/ 99m Tc-sestamibi and 11 C-methionine PET/CT in the present study in the reoperative setting of hyperparathyroidism was similar both with regards to the correct side (59% vs. 65%; k-coefficient, 0.42) and more specific localization (48% vs. 61%; k-coefficient, 0.57).…”

Section: Discussionmentioning

confidence: 99%

Planar Scintigraphy with ¹²³I/^99mTc-Sestamibi, ^99mTc-Sestamibi SPECT/CT, ¹¹C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?

et al. 2013

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All patients with primary hyperparathyroidism should undergo localization studies before reoperation, but it is not known which method is most accurate. The purpose of this prospective study was to compare the performance of planar scintigraphy with 123 I/ 99m Tc-sestamibi, 99m Tc-sestamibi SPECT (SPECT/CT), 11 C-methionine PET/CT, and selective venous sampling (SVS) in persistent primary hyperparathyroidism. Methods: Twenty-one patients referred for reoperation of persistent hyperparathyroidism were included and investigated with 123 I/ 99m Tc-sestamibi, SPECT/CT (n 5 19), 11 C-methionine PET/CT, and SVS (n 5 18) before reoperation. All patients had been operated on 1-2 times previously because of hyperparathyroidism. The results of the localization studies were compared with operative findings, histology, and biochemical cure. Results: Eighteen (86%) of 21 patients were biochemically cured. Nineteen parathyroid glands (9 adenomas, 1 atypical adenoma, and 9 hyperplastic glands) were removed from 17 patients, and 1 patient who was biochemically cured had an unclear histology result. The accuracy for localizing a pathologic parathyroid gland to the correct side of the neck was 59% (95% confidence interval [CI], 36%-79%) for 123 I/ 99m Tc-sestamibi, 19% (95% CI, 5%-42%) for SPECT/CT, 65% (95% CI, 43%-84%) for 11 C-methionine PET/CT, and 40% (95% CI, 19%-65%) for SVS (P , 0.01 for 123 I/ 99m Tc-sestamibi vs. SPECT/ CT). The corresponding accuracy for the correct quadrant or more specific site was 48% (95% CI, 27%-69%) for 123 I/ 99m Tc-sestamibi, 14% (95% CI, 3%-36%) for SPECT/CT, 61% (95% CI, 39%-80%) for 11 C-methionine PET/CT, and 25% (95% CI, 9%-49%) for SVS (P , 0.02 for 123 I/ 99m Tc-sestamibi vs. SPECT/CT). In the 3 patients not cured, preoperative 123 I/ 99m Tc-sestamibi and SPECT/CT remained negative, SVS was false predictive in all, and 11 C-methionine PET/CT in 1. 11 C-methionine PET/CT accurately revealed the pathologic gland in 4 of 8 (50%) patients with a negative 123 I/ 99m Tc-sestamibi scan result, all of whom were biochemically cured after reoperation. Conclusion: Planar scintigraphy with 123 I/ 99m Tc-sestamibi performs well in complicated primary hyperparathyroidism and is recommended as first-line imaging before reoperation. 11 C-methionine PET/CT provides valuable additional information if 123 I/ 99m Tc-sestamibi scan results remain negative. 99m Tc-sestamibi SPECT/CT and SVS provide no additional information, compared with the combined results of 123 I/ 99m Tcsestamibi and 11 C-methionine PET/CT imaging.Key Words: primary hyperparathyroidism; persistent; reoperation; 123 I/ 99m Tc-sestamibi; SPECT-CT; 11 C-methionine PET/CT; selective venous sampling; PTH Nucl Med 2013; 54:739-747 DOI: 10.2967/jnumed.112.109561 Pri mary hyperparathyroidism is a common endocrine disease, with a peak incidence in women aged 50-60 y (1). It is explained by a single parathyroid adenoma in 80%-85% of patients, double adenomas in about 4%, and parathyroid hyperplasia in 15%-20% of cases. Parathyroid carcinoma is...

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Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

Lee

Shim

Jeong

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Accurate preoperative localization of primary hyperparathyroidism (pHPT) is an important and challenging issue for a successful parathyroidectomy. Although new imaging modalities have been introduced during the past decade, direct comparative studies on advanced imaging techniques are limited.OBJECTIVE To compare the performance of different preoperative imaging modalities for the localization of pHPT by performing a network meta-analysis (NMA).

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Accurate pre‐operative localization of pathological parathyroid glands using ¹¹C‐methionine PET/CT

Abstract: MET-PET/CT appears a reliable technique to guide MAS of parathyroid glands.

Cited by 50 publications

References 25 publications

Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

Planar Scintigraphy with ¹²³I/^99mTc-Sestamibi, ^99mTc-Sestamibi SPECT/CT, ¹¹C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?

Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

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Accurate pre‐operative localization of pathological parathyroid glands using 11C‐methionine PET/CT

Abstract: MET-PET/CT appears a reliable technique to guide MAS of parathyroid glands.

Cited by 50 publications

References 25 publications

Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

Detection and Characterization of Parathyroid Adenoma/Hyperplasia for Preoperative Localization: Comparison Between 11C-Methionine PET/CT and 99mTc-Sestamibi Scintigraphy

Planar Scintigraphy with 123I/99mTc-Sestamibi, 99mTc-Sestamibi SPECT/CT, 11C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?

Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism

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Accurate pre‐operative localization of pathological parathyroid glands using ¹¹C‐methionine PET/CT

Planar Scintigraphy with ¹²³I/^99mTc-Sestamibi, ^99mTc-Sestamibi SPECT/CT, ¹¹C-Methionine PET/CT, or Selective Venous Sampling Before Reoperation of Primary Hyperparathyroidism?