Comparison of 4D computed tomography and F‐18 fluorocholine PET for localisation of parathyroid lesions in primary hyperparathyroidism: A systematic review and meta‐analysis

Abstract

Minimally invasive parathyroidectomy (MIP) is the standard of care for primary hyperparathyroidism (PHPT). Four dimensional computed tomography(4DCT) and F-18 Fluorocholine positron emission tomography/computed tomography (FCH PET/CT) localize adenomas accurately to perform MIP. We aimed to conduct a systematic review and metanalysis to evaluate the diagnostic performance of 4DCT and FCH PET/CT scan for quadrant wise localisation in PHPT patients and to do head-to-head comparison between these two modalities.Design, Patients and Measurement : After searching through PubMed and EMBASE databases, 46 studies (using histology as a gold standard) of 4DCT and FCH PET/CT were included.Results: Total number of patients included were 1651 and 952 for 4DCT scan (studies n = 26) and FCH PET/CT scan (studies n = 24) respectively. In per patient analysis, FCH PET/CT and 4DCT had pooled sensitivities of 92% (88−94) and 85% (73−92) respectively and in per lesion analysis, 90% (86−93) and 79% (71−84), respectively. In the subgroup with negative conventional imaging/persistent PHPT, FCH PET/CT had comparable sensitivity to 4DCT (84% [74−90] vs. 72% [46−88]). As per patient wise analysis, FCH PET/CT had better detection rates than 4DCT ([92.4 vs. 76.85], odds ratio −3.89 [1.6−9.36] p = .0024) in the subpopulation where both FCH PET/CT and 4DCT were reported. Conclusion:Both 4DCT and FCH PET/CT scan performed well in newly diagnosed patients, patients with persistent disease and in those with inconclusive conventional imaging results. FCH PET/CT scan had a higher pooled sensitivity than 4DCT in detecting patients with PHPT in head to head comparison.

The impact of perioperative diagnostic tools on clinical outcomes and cost-effectiveness in parathyroid surgery: a health economic evaluation

“…A plausible explanation for reaching a comparable conclusion might lie in the inclusion of MGD cases in our study, for which the preoperative localization is considerably less accurate. 6,7…”

“…17 The sensitivity and positive predictive value (PPV) of ultrasonography in MGD were obtained from a systematic literature review between 1995 and 2003. 7 The sensitivity and PPV of SPECT/CT, 4D-CT and FCH-PET/CT were retrieved from the latest systematic reviews 6,8 , whereas the sensitivity and PPV for FCH-PET/CT in MGD was taken from a single-institution study. 9 The sensitivity and specificity of the different ioPTH criteria were estimated from two single-institution studies with 570 patients.…”

“…5 However, the sensitivity and specificity of a preoperative localization vary not only between the different preoperative diagnostic modalities but also between single adenomas and MGD. [6][7][8][9] If an FP is performed, an intraoperative parathyroid hormone (ioPTH) monitoring is recommended to exclude MGD and to avoid reoperations. 10 The two most common criteria for defining surgical success, measured as a 50% decline of the ioPTH level 10 minutes after resection, use different baselines.…”

“…5 However, the sensitivity and specificity of a preoperative localization vary not only between the different preoperative diagnostic modalities but also between single adenomas and MGD. 6–9…”

Endocrinology application of molecular imaging: current role of PET/CT

“…Primary hyperparathyroidism (pHPT) is the third most common endocrine disease, in most cases due to inappropriate secretion of parathyroid hormone by one or more parathyroid adenomas [15]. Minimally invasive parathyroidectomy represents standard of care in pHPT as it can lead to clinical complications (hypercalcemia, kidney stones or osteoporosis) [16], even though asymptomatic at diagnosis in 80% [17]. Precise preoperative identification of parathyroid adenomas is crucial because minimally invasive surgery reduces surgical complications and expedites patients' recovery therefore preoperative imaging for parathyroid adenomas is of great importance [18].…”