Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT

Abstract

We aimed to assess the value of 11 C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99m Tc-sestamibi imaging and neck ultrasound. Methods: Eightyseven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUV max and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11 C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had falsepositive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUV max was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11 C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99m Tc-sestamibi imaging yield negative or discordant results.

A retrospective analysis of the diagnostic performance of 11C-choline PET/CT for detection of hyperfunctioning parathyroid glands after prior negative or discordant imaging in primary hyperparathyroidism

“…The combined use of these scans can reach a sensitivity of 80-90% [3][4][5]. For the remaining 10-20% of patients, a BNE could be avoided if other innovative functional imaging techniques using positron emission tomography (PET)/CT, with radiotracers such as 11 C-methionine and 11 C-choline/ 18 F-fluorocholine, would be able to localize the adenoma [6][7][8][9][10].…”

Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview

“…In terms of sensitivity, both [ 11 C]labeled and [ 18 F]labeled choline showed higher performance compared with traditional imaging methods. The results from a large sample of patients studied by Orevi et al showed a higher sensitivity of [ 11 C]Choline PET/CT (92.3%) when compared with [ 99m Tc]Tc-MIBI (88.5%) in parathyroid adenoma detection [18], up to 98% of sensitivity in other studies [38,42].…”

Lokalisationsdiagnostik von Nebenschilddrüsenadenomen mittels PET/CT

“…Die 18 F-Cholin PET/CT eignet sich insbesondere für den Fall negativer oder diskordanter Ergebnisse der regulären Bildgebung, für die Planung von Re-Operationen und für die Detektion ektoper Nebenschilddrüsenadenome [34]. Ähnlich vielversprechend erscheint die PET/ CT-Diagnostik mit 11 C-Cholin [17], aufgrund der kurzen Halbwertszeit ist diese aber Zentren mit einem Zyklotron vorbehalten und für die flächendeckende Routineversorgung eher ungeeignet.…”

“…Als Positronenstrahler wurde zunächst 11 C verwendet (Aktivität 385 MBq; Bildakquise nach circa 20 Minuten). In einer kürzlich veröffentlichen Arbeit zeichnete sich die PET/CT mit 11 C-Cholin mit einer Sensitivität von 98,8 % und einer Detektionsrate von 99 % aus[17]. Des Weiteren wird 11 C-Methionin als PET-Radiotracer zur Detektion von Nebenschilddrüsenadenomen angewendet.…”