Is 18F-Fluorocholine-Positron Emission Tomography/Computerized Tomography a New Imaging Tool for Detecting Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism?

Abstract

As the main result of this pilot study, we show that in patients with hyperparathyroidism and with discordant or equivocal results on scintigraphy or on ultrasonography, adenomatous or hyperplastic parathyroid glands can be localized by FCH-PET/CT with good accuracy. Furthermore, FCH-PET/CT can solve discrepant results between preoperative ultrasonography and scintigraphy and has thus a potential as a functional imaging modality in the detection of abnormal parathyroid glands. Our preliminary results are encouraging and prompt us to further evaluate FCH-PET/CT as a functional imaging agent in patients with biochemical hyperparathyroidism.

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

“…99 Tc sestamibiscintigraphy with/without single-photon emission computed tomography (SPECT) is appreciated by some surgeons to exclude ectopic parathyroid localization despite convincing evidence in defined multiglandular disease. Therefore, enhanced localization measures including 99 Tc sestamibi-scintigraphy with/without SPECT and CT, MRI, (11) C-methionine PET-CT or 18 F-FDG-PET-CT as well as selective venous catheterization with PTH assessment presently appear to be reserved for special indications and possibly rare reoperative situations, since standard conventional bilateral exploration in renal HPT does not rely on preoperative localization [14][15][16].…”

18F-Choline PET/CT as a New Tool for Functional Imaging of Non-Proliferating Secreting Neuroendocrine Tumors

“…However, we present the histopathological analysis of a choline-positive secreting differentiated neuroendocrine tumor in three patients with very low proliferation rate, proving that high choline uptake in tumors can also be induced by other biological processes. This finding contributes to better understanding of the tumor biology behind the recently demonstrated applicability of choline PET for imaging of benign secreting tumors, such as parathyroid adenomas [2,3].…”

“…After several incidental discoveries of functioning parathyroid gland adenomas [23][24][25], choline PET has been advocated as a new tool for the detection and localization of these hyperfunctioning lesions [2,3,26]. However, the biological processes behind the uptake of choline in parathyroid adenomas have not been evaluated or described.…”

Comparison of minimally invasive parathyroidectomy under local anaesthesia and minimally invasive video-assisted parathyroidectomy for primary hyperparathyroidism: a cost analysis

“…More advanced imaging techniques can be useful in some circumstances: the Multiphase Computed Tomography is a well-detailed diagnostic tool, the results of which are still under evaluation (27); the Magnetic Resonance Imaging can help in the localization of mediastinal parathyroid (26). Other advanced diagnostic methods, such as the 18F-fluorodeoxyglucose, 11C-methionine and the 8F-fluorocholine-PET/CT have been studied with debated result, and only the last one showed, in a pilot study, encouraging results (28) and, in any case, these are costly and not widely diffused tools. Due to the uncertainty of the preoperative diagnostic imaging, some intraoperative tools have been proposed for improving the diagnostic performance and the cure rate of the PHPT.…”