The role of 18F-FCH PET/CT in patients with uremic hyperparathyroidism compared with 99mTc-sestaMIBI SPECT/CT and ultrasonography

Yu, Xue; Li, Wenbo; Xia, Zhu; Chengming, Lei; Cao, Yiyi; Wang, Zhengjie; Hua, Peng

doi:10.1186/s13550-019-0583-9

Cited by 11 publications

(7 citation statements)

References 34 publications

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“…On the other hand, when we compared 18F-FCH PET/CT with the other diagnostic techniques, in particular neck US, 18F-FCH PET/CT had low specificity with higher rates of false positive results in patients with both sHPT and tHPT. These findings are consistent with the data previously reported by Xue et al [ 27 ] and Chen et al [ 28 ] in similar populations of CKD patients with HPT. A recent study revealed excellent results for PET/CT with 11C-Metionine (11C-MET) as a second-line preoperative technique after negative first-line ultrasound and scintigraphy in patients with tertiary hyperparathyroidism.…”

Section: Discussionsupporting

confidence: 94%

“…In recent years, positron emission tomography/computed tomography (PET/CT) with 18F-fluorocholine (18F-FCH) has emerged as a second-line imaging procedure which offers high resolution, low radiation exposure in comparison with 4D CT, and shorter examination times in patients with primary HPT (pHPT), and even in patients with a history of PTX [ 22 , 23 , 24 , 25 , 26 ]. Unlike what has previously been published for pHPT, informative data on the use of 18F-FCH PET/CT in patients with CKD and HPT are limited [ 27 , 28 ]. Moreover, patients are usually analyzed without clear separation between sHPT and tHPT, which seems to be a questionable methodological choice when considering the underlying different pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

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18F-Fluorocholine PET/CT Compared with Current Imaging Procedures for Preoperative Localization of Hyperfunctioning Parathyroids in Patients with Chronic Kidney Disease

et al. 2023

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Hyperparathyroidism (HPT) in patients with chronic kidney disease (CKD) includes secondary (sHPT) and tertiary hyperparathyroidism (tHPT). Considering that the role of preoperative imaging in the clinical setting is controversial, in the present study we have retrospectively compared pre-surgical diagnostic performances of 18F-Fluorocholine (18F-FCH) PET/CT, cervical ultrasonography (US), parathyroid scintigraphy, and 4D-CT in a group of 30 patients with CKD and HPT (18/12 sHPT/tHPT), 21 CKD G5 including 18 in dialysis, and 9 kidney transplant recipients. All patients underwent 18F-FCH, and 22 had cervical US, 12 had parathyroid scintigraphy, and 11 had 4D-CT. Histopathology was the gold standard. Seventy-four parathyroids were removed: 65 hyperplasia, 6 adenomas, and 3 normal glands. In the whole population, in a per gland analysis, 18F-FCH PET/CT was significantly more sensitive and accurate (72%, 71%) than neck US (25%, 43%), parathyroid scintigraphy (35%, 47%), and 4D-CT (40%, 47%). The specificity of 18F-FCH PET/CT (69%) was lower than that of neck US (95%) and parathyroid scintigraphy (90%), without, however, achieving significance. 18F-FCH PET/CT was more accurate than all other diagnostic techniques when sHPT and tHPT patients were considered separately. 18F-FCH PET/CT sensitivity was significantly higher in tHPT (88%) than in sHPT (66%). Three ectopic hyperfunctioning glands (in three different patients) were all detected by 18F-FCH PET/CT, two by parathyroid scintigraphy, and none by cervical US and 4D-CT. Our study confirms that 18F-FCH PET/CT is an effective preoperative imaging option in patients with CKD and HPT. These findings may be of greater importance in patients with tHPT (who could benefit from minimally invasive parathyroidectomy) than in patients with sHPT, who often undergo bilateral cervicotomy. In these cases, preoperative 18F-FCH PET/CT may be helpful in locating ectopic glands and may guide the surgical choice for gland preservation.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

18F-Fluorocholine PET/CT Compared with Current Imaging Procedures for Preoperative Localization of Hyperfunctioning Parathyroids in Patients with Chronic Kidney Disease

et al. 2023

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“…To understand the diagnostic e cacy of 18 F-FCH PET/CT for hyperplasia and adenoma, respectively, we analyzed each lesion separately and found that the detection rate of PET/CT was signi cantly higher for adenoma than for hyperplasia (97.06% vs. 68.29%). Further analysis revealed that lesion size affected the PET imaging results of the hyperplastic lesions, with the lesions in the PET-positive group being signi cantly larger than those in the PET-negative group (1.34 ± 0.431 cm vs. 0.91 ± 0.480 cm).This may be due to the fact that smaller lesions have relatively few functional-like cells, which do not have high uptake of the imaging agent and are thus easily missed [13,14]. In addition, Boccalatte et al [15].…”

Section: Discussionmentioning

confidence: 98%

Value of 18F-FCH PET/CT for Diagnosing and Differentiating Hyperplasia From Adenoma

Li,

Liu,

Wang

et al. 2023

Preprint

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Objective: Due to the different surgical approaches for hyperplasia and adenoma in primary hyperparathyroidism, accurate preoperative diagnosis and identification are key factors affecting the surgery. 18F-FCH PET/CT imaging is one of the effective methods for preoperative localization of hyperparathyroidism and can quantify parathyroid function by metabolic parameters. Therefore, the aim of this study was to analyze the diagnostic and differential value of 18F-FCH PET/CT for hyperplasia and adenoma. Methods: This was a retrospective analysis of data related to 63 patients undergoing 18F-FCH PET/CT at the First Hospital of Chongqing Medical University between December 2017 and December 2022. All procedures were completed, and postoperative pathological data were available for all patients. Comparison of laboratory parameters such as PTH and serum calcium between different patients to assess whether hyperplasia and adenoma can be distinguished based on laboratory indices, and analysis of PET/CT diagnosis and differences in metabolic parameters based on individual parathyroid lesions.The Mann–Whitney U test and binary logistic stepwise regression analysis were also used for univariate and multivariate analyses of information related to hyperplasia and adenomas, and the indicators found to be significant on multivariate analysis were used to determine cutoff values by receiver operating characteristic analysis. Results: A total of 75 parathyroid lesions were ultimately removed postoperatively in 63 patients, including 41 hyperplasia and 34 adenoma, and multiple lesions were present simultaneously in 9 patients. There were no significant differences in laboratory parameters between the different patient groups (P > 0.05). Based on the analysis of individual lesions, the sensitivity of PET/CT for the diagnosis of hyperplasia was 68.29% and that of adenoma was 97.06%. The sensitivity of PET/CT for adenoma was significantly higher than that of hyperplasia, and the size of the lesion may be the main factor affecting the sensitivity; in terms of differences in metabolic parameters, dual-phase SUVmax, MTV and TLG were significant in univariate analysis, and multivariate analysis showed the delayed TLG (cut-off value of 6.421) was a more reliable index for differentiating hyperplasia from adenoma (P=0.002). Conclusion: The diagnostic value of 18F-FCH PET/CT for adenoma is higher than that of hyperplasia. Delayed TLG can differentiate hyperplasia from adenoma at the imaging level and help in the selection of clinical treatment options.

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“…Few reports in the literature indicate the high usefulness of [ 18 F]FCH in preoperative diagnostics in patients with tHPT. In a Chinese study from 2019, which included a group of 17 dialysis patients with hyperparathyroidism, Xue et al assessed the sensitivity of PET/CT with [ 18 F]FCH to be 84.1% (with 100% specificity and 86.5% accuracy) [ 26 ]. Positive PET/CT results with [ 18 F]FCH were obtained in all patients included in the study, and no false positives were found.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism

Kołodziej

Saracyn

Lubas³

et al. 2022

Nutrients

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Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [11C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed.

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The role of 18F-FCH PET/CT in patients with uremic hyperparathyroidism compared with 99mTc-sestaMIBI SPECT/CT and ultrasonography

Cited by 11 publications

References 34 publications

18F-Fluorocholine PET/CT Compared with Current Imaging Procedures for Preoperative Localization of Hyperfunctioning Parathyroids in Patients with Chronic Kidney Disease

18F-Fluorocholine PET/CT Compared with Current Imaging Procedures for Preoperative Localization of Hyperfunctioning Parathyroids in Patients with Chronic Kidney Disease

Value of 18F-FCH PET/CT for Diagnosing and Differentiating Hyperplasia From Adenoma

Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism

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