Incidental Detection of Parathyroid Adenoma on Somatostatin Receptor PET/CT and Incremental Role of 18F-Fluorocholine PET/CT in MEN1 Syndrome

Arora, Saurabh; Damle, Nishikant; Passah, Averilicia; Yadav, Madhav P.; Ballal, Sanjana; Aggarwal, Vivek; Gupta, Yashdeep; Kumar, Praveen; Tripathi, Madhavi; Bal, Chandrasekhar

doi:10.1007/s13139-018-0520-2

Cited by 8 publications

(4 citation statements)

References 20 publications

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“…In patients for whom MIBI is unable to localize the lesions accurately, it is possible to improve the localization by addition of FCH PET/CT. FCH PET/CT has also been found useful in multiple parathyroid adenomas and in hyperplasia where MIBI may have reduced localization rates [6, 9, 10]. This further reduces the surgical failure rate.…”

Section: Discussionmentioning

confidence: 99%

Impact of Fluoro‐Choline PET/CT in Reduction in Failed Parathyroid Localization in Primary Hyperparathyroidism

Aphale

Damle²,

Chumber³

et al. 2023

World j. surg.

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Introduction Accurate localization of the pathological parathyroid gland is a prerequisite for minimally invasive surgical management of hyperparathyroidism (HPT). Poor imaging or discordance in odd situations like ectopic adenomas, parathyroid hyperplasia, syndromic HPT results in localization dilemma thus causing failed parathyroidectomy. We studied the impact of Fluoro‐Choline (FCH) PET/CT imaging in reduction in localization failure of parathyroid adenoma. Materials and methods We did a retrospective observational study (2018–2021) of HPT among which 97 patients underwent focused parathyroidectomy (FP). All patients had undergone ultrasound imaging and 99mTc‐sestaMIBI scan with early SPECT/CT (MIBI). When this preliminary imaging was doubtful or negative or multiple lesions were expected, FCH PET/CT was performed. We compared the localization accuracy of MIBI scan and FCH PET/CT with surgical outcomes as reference standard. Results MIBI scan showed overall lesion detection rate (LDR) of 88.65% in localization of pathological parathyroid gland in 97 patients. The addition of FCH PET/CT improved the overall lesion detection to 97.9%. The overall possible localization failure was reduced from 11.34 to 2.06% with the addition of FCH PET/CT (p < 0.05). Out of 97 patients of FP, 87 patients showed features of parathyroid adenoma. Single hyperplastic gland was seen in 7 patients, lipoadenoma was seen in 1 patient and 1 patient had features suggestive of parathyroiditis on histopathology. FCH PET/CT was a useful adjunct and showed significant reduction in localization failure of parathyroid adenoma.

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Section: Discussionmentioning

confidence: 99%

Impact of Fluoro‐Choline PET/CT in Reduction in Failed Parathyroid Localization in Primary Hyperparathyroidism

Aphale

Damle²,

Chumber³

et al. 2023

World j. surg.

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“…The sensitivities for US and MIBI range between 59–89% and 63–84%, respectively, which leaves a substantial amount of cases with unclear findings, necessity of more extensive surgical exploration, and a higher risk of persistent disease after surgical treatment ( 7 ). In addition, the sensitivities are low in cases with small parathyroid lesions due to the poor spatial resolution, or when the adenoma is in close proximity to the thyroid gland, and in multi gland involvement with hyperplasia ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism

Luong

Rejnmark

Arveschoug

et al. 2020

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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Multiple endocrine neoplasia 1 (MEN1) is a rare genetic syndrome characterized by the manifestation of tumors in endocrine glands most often in the parathyroid gland (PG). Treatment may involve several parathyroidectomies (PTX), especially in young patients, which increases the risk of postoperative complications. We present a 16-year-old patient with a family history of MEN1 syndrome. The patient started to show biochemical signs of hyperparathyroidism (HPT) and hypercalcemia at the age of 10. One and a half years later a PTX was successfully performed with removal of the two left PGs. However, a rise in plasma parathyroid hormone and ionized calcium was observed 4 years later. Preoperative noninvasive imaging with 99mTc-sestamibi scintigraphy showed no definitive parathyroid adenoma. A 11C-methionine position emission tomography combined with MRI (MET-PET/MRI) was then performed and detected a focus posterior to the lower part of the right thyroid lobe. Intraoperative angiography with fluorescence and indocyanine green dye was used to assess the vascularization of the remaining PGs. The lower right PG was removed. The patient was discharged with normalized biochemical values and without postoperative complications. Recurrence of primary HPT is frequent in MEN1 patients which often necessitates repeated operations. Our case report showed that the use of advanced noninvasive preoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken into consideration in selected cases to avoid postoperative complications. To our knowledge, this is the first case where MET-PET/MRI has been used to detect parathyroid pathology. Learning points: MEN1 patients will develop parathyroid disease, which eventually will lead to surgical treatment with removal of the pathological glands. Preoperatively usage of MRI combined with PET tracers such as 11C-methionine and 18F-Fluorocholine are able to detect parathyroid pathology with a higher sensitivity than conventional imaging. Techniques using intraoperatively angiography with fluorescence and florescent dyes allow surgeons to verify the vascularization of each parathyroid gland. Optimization of noninvasive preoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken into consideration when performing PTX consecutively in the same patient to avoid postoperative complications.

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“…Two cases proved to be malignant (29%), including retiform hemangioendothelioma in soft tissue and a non-Hodgkins lymphoma in a lymph node [15,27]. The remaining five benign cases revealed a pleomorphic adenoma in the parotid gland, parathyroid adenoma in close relation to the thyroid gland, elastofibroma dorsi in soft tissue, a uterine leiomyoma, and fibrous dysplasia in the femoral bone [8,[28][29][30][31].…”

Section: Miscellaneousmentioning

confidence: 99%

Prevalence and significance of incidental findings on 68 Ga-DOTA-conjugated somatostatin receptor-targeting peptide PET/CT: a systematic review of the literature

2022

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Aim We aimed to evaluate the prevalence of incidental 68 Ga-DOTA-conjugated somatostatin receptor-targeting peptide PET/CT (SSTR PET/CT) findings, their clinical significance in the need for follow-up, and their risk of malignancy. Materials and methods Studies reporting incidental SSTR PET/CT findings were systematically searched in PubMed, Cochrane, Embase and Web of Science literature published prior to 1st of May 2020. Studies were filtered by two independent readers for eligibility based on title and abstract, and subsequently on full text. The main exclusion criteria were: 1) pathological findings that matched scan indication, 2) known organ specific disease and/or incidental findings confirmed on other scan modality prior to SSTR PET/CT, 3) lack of diagnosis and/or follow up, and 4) results published in proceedings or conference abstracts. Results Twenty-one studies, comprising a total of 2906 subjects, were eligible for the analysis. Studies included were retrospective cohort studies on incidental SSTR PET/CT findings in a specific organ (n = 2888, 7/21) or case reports (n = 18, 14/21). A total of 133 subjects had incidental SSTR PET/CT findings. Incidental findings were predominantly seen in the thyroid gland (n = 65), spine (n = 30), brain (n = 26) and breast (n = 6). Seventeen of 133 (13%) incidental findings were malignant on final diagnosis. Incidental breast findings were associated with the highest risk of malignancy (67%). In the thyroid, incidental SSTR uptake was caused by malignancy in 8%, all presenting as focal uptake. The lowest risk was seen in the spine with a malignancy rate of 3% in patients with incidental SSTR uptake and benign cases were interpreted as vertebral hemangiomas on CT. Incidental SSTR PET/CT findings in other locations were of malignant etiology in two out of six cases (33%) and should be evaluated individually. Conclusion The most incidental SSTR PET/CT findings were found in the thyroid gland, spine, and brain. The risk of malignancy was greatest in incidental SSTR PET/CT findings in the breast, cranially, and thyroid gland. The results of the present study can prove useful in the interpretation of atypical findings on SSTR PET/CT and in the counseling of clinicians.

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Incidental Detection of Parathyroid Adenoma on Somatostatin Receptor PET/CT and Incremental Role of 18F-Fluorocholine PET/CT in MEN1 Syndrome

Cited by 8 publications

References 20 publications

Impact of Fluoro‐Choline PET/CT in Reduction in Failed Parathyroid Localization in Primary Hyperparathyroidism

Impact of Fluoro‐Choline PET/CT in Reduction in Failed Parathyroid Localization in Primary Hyperparathyroidism

Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism

Prevalence and significance of incidental findings on 68 Ga-DOTA-conjugated somatostatin receptor-targeting peptide PET/CT: a systematic review of the literature

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