Is C‐11 Methionine PET/CT Able to Localise Sestamibi‐Negative Parathyroid Adenomas?

Weber, Theresia; Gottstein, M.; Schwenzer, Sabrina; Beer, Ambros J.; Luster, Markus

doi:10.1007/s00268-016-3795-4

Cited by 33 publications

(26 citation statements)

References 23 publications

(41 reference statements)

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“…11 C-Methionine is the PET tracer that has been most investigated for the assessment of PHPT in the last decade [22, 27–29]. The sensitivity and specificity found in this study were better than the reported pooled sensitivity and specificity of 86% and 86%, respectively, found in a per patient-based analysis of 11 C-methionine PET/CT in the evaluation of patients with PHPT and negative 99m Tc-MIBI SPECT [30].…”

Section: Discussionmentioning

confidence: 66%

“…However, some studies have shown a sensitivity of about 71%, leading to false-negative results in one-third of patients with biochemical evidence of PHPT. Moreover, this approach has limited value in multiglandular disease, which is the cause of hyperparathyroidism in 5–15% of cases and is therefore associated with the risk of surgical failure [22]. …”

Section: Discussionmentioning

confidence: 99%

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18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients

Beheshti

Hehenwarter

Paymani

et al. 2018

Eur J Nucl Med Mol Imaging

117

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PurposeIn this prospective study we compared the accuracy of 18F-fluorocholine PET/CT with that of 99mTc-MIBI or99mTc-tetrofosmin SPECT/CT in the preoperative detection of parathyroid adenoma in patients with primary hyperparathyroidism. We also assessed the value of semiquantitative parameters in differentiating between parathyroid hyperplasia and adenoma.MethodsBoth 18F-fluorocholine PET/CT and 99mTc-MIBI/tetrofosmin SPECT/CT were performed in 100 consecutive patients with biochemical evidence of primary hyperparathyroidism. At least one abnormal focus on either 18F-fluorocholine or 99mTc-MIBI/tetrofosmin corresponding to a parathyroid gland or ectopic parathyroid tissue was considered as a positive finding. In 76 patients with positive findings on at least one imaging modality, surgical exploration was performed within 6 months, and the results were related to histopathological findings and clinical and laboratory findings at 3–6 months as the standard of truth. In 24 patients, no surgery was performed: in 18 patients with positive imaging findings surgery was refused or considered risky, and in 6 patients imaging was negative. Therefore, data from 82 patients (76 undergoing surgery, 6 without surgery) in whom the standard of truth criteria were met, were used in the final analysis.ResultsAll patients showed biochemical evidence of primary hyperparathyroidism with a mean serum calcium level of 2.78 ± 0.34 mmol/l and parathormone (PTH) level of 196.5 ± 236.4 pg/ml. The study results in 76 patients with verified histopathology and 3 patients with negative imaging findings were analysed. Three of six patients with negative imaging showed normalized serum PTH and calcium levels on laboratory follow-up at 3 and 6 months, and the results were considered true negative. In a patient-based analysis, the detection rate with 18F-fluorocholine PET/CT was 93% (76/82), but was only 61% (50/82) with 99mTc-MIBI/tetrofosmin SPECT/CT. In a lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of 18F-fluorocholine PET/CT in the detection of parathyroid adenoma were 93.7%, 96.0%, 90.2%, 97.4% and 95.3%, respectively, and of 99mTc-MIBI/tetrofosmin SPECT/CT were 60.8%, 98.5%, 94.1%, 86.3% and 87.7%, respectively. Although 18F-fluorocholine PET-positive adenomatous lesions showed higher SUVmax values than the hyperplastic glands (6.80 ± 3.78 vs. 4.53 ± 0.40) in the semiquantitative analysis, the difference was not significant (p = 0.236). The mean size (measured as the length of the greatest dimension) and weight of adenomas were 15.9 ± 7.6 mm (median 15 mm, range 1–40 mm) and 1.71 ± 1.86 g (median 1 g, range: 0.25–9 g), respectively. Among the analysed parameters including serum calcium and PTH and the size and weight of parathyroid adenomas, size was significantly different between patients with negative 99mTc-MIBI/tetrofosmin SPECT/CT and those with positive 99mTc-MIBI/tetrofosmin SPECT/CT (mean size 13.4 ± 7.6 mm vs. 16.9 ± 7.4 mm, respectively; p = 0.042)....

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients

Beheshti

Hehenwarter

Paymani

et al. 2018

Eur J Nucl Med Mol Imaging

117

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“…However, the modality most utilized is nuclear medicine isotopic imaging using various radiopharmaceuticals. Although newer positron emission tomography radiopharmaceuticals including C-11 methionine [11,12], and F-18 fluorocholine [13,14] have been investigated, the mainstay of radionuclide imaging in hyperparathyroidism relies on Tc-99m sestamibi which localizes in hyperfunctioning parathyroid glands. Several imaging protocols have been used.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

et al. 2018

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“…When a state-of-the-art combined Tc-99m pertechnetate thyroid scintigraphy and Tc-99m sestamibi parathyroid scintigraphy fail to visualize a parathyroid adenoma, a supplementary 11C-Methionine PET/CT often visualizes a parathyroid adenoma, enabling focused parathyroidectomy ( 1 , 2 , 3 ). 18F-Fluorocholine PET/CT is an alternative add-on examination for improvement of preoperative localization of parathyroid adenoma in case of a negative parathyroid scintigraphy ( 4 , 5 ).…”

Section: Discussionmentioning

confidence: 99%

Follicular thyroid cancer avid on C-11 Methionine PET/CT

Jochumsen

Iversen

Arveschoug

2018

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryA case of follicular thyroid cancer with intense focal Methionine uptake on 11C-Methionine PET/CT is reported here. The use of 11C-Methionine PET in differentiated thyroid cancer is currently being investigated as a surrogate tracer compared to the more widely used 18F-FDG PET. This case illustrates the potential incremental value of this modality, not only in the localizing of parathyroid adenoma, but also indicating that 11C-Methionine PET might have a potential of increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.Learning points:11C-Methionine PET/CT and 18F-Fluorocholine PET/CT often visualizes the parathyroid adenoma in case of negative Tc-99m-MIBI SPECT/CT.A cold nodule in Tc-99m Pertechnetat thyroid scintigraphy with a negative Sestamibi scintigraphy has a very low probability of being malignant.However, the pretest likelihood of thyroid cancer in a cold nodule with increased Sestamibi uptake is low.11C-Methionine PET might have a potential incremental value in increasing the pretest likelihood of thyroid malignancy in a cold nodule with highly increased Sestamibi uptake.

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Is C‐11 Methionine PET/CT Able to Localise Sestamibi‐Negative Parathyroid Adenomas?

Abstract: Additional pre-interventional imaging with Met-PET/CT was able to identify hyperfunctioning parathyroid glands in 74% of patients with pHPT and negative sestamibi scans, thus enabling successful parathyroid surgery.

Cited by 33 publications

References 23 publications

18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients

18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients

Diagnostic accuracy of planar, SPECT, and SPECT/CT parathyroid scintigraphy protocols in patients with hyperparathyroidism

Follicular thyroid cancer avid on C-11 Methionine PET/CT

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