The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas

Khafif, Avi; Masalha, Muhamed; Landsberg, Roee; Domachevsky, Liran; Bernstine, Hanna; Groshar, David; Azoulay, Ofer; Lockman, Yehudit

doi:10.1007/s00405-019-05301-2

Cited by 20 publications

(21 citation statements)

References 23 publications

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“…A pilot study demonstrated that FCH PET/CT is comparable in performance to 4D-CT [25], a recent study showed that the combination of FCH PET with 4D-CT was of added value [18], and a third study concluded that 4D-CT appears as a confirmatory imaging modality [19]. Furthermore, an interesting development is the use of FCH PET/MRI, with the reduction of radiation dose and increased soft-tissue resolution [16, 26, 27].…”

Section: Discussionmentioning

confidence: 99%

Parathyroid imaging with 18F-fluorocholine PET/CT as a first-line imaging modality in primary hyperparathyroidism: a retrospective cohort study

et al. 2019

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Background 18 F-fluorocholine (FCH) PET/CT is a promising technique for visualizing hyperfunctioning parathyroid glands in hyperparathyroidism. It is still under debate whether to use this technique as a first-line imaging modality or to use it when conventional techniques such as 99m Tc-sestamibi scintigraphy or ultrasonography are inconclusive. This study evaluates FCH PET/CT as a first-line modality. Methods Patients with primary hyperparathyroidism, referred between June 2015 and December 2018 for FCH PET/CT as a first-line imaging method, were included in this study. Baseline characteristics, clinical data, scan results, and type of treatment were recorded. The rate of correct detection was calculated on a per patient-based and a per lesion-based analysis. The reference standard comprised histopathological results, intraoperative response to parathyroidectomy, and clinical follow-up. Results Two hundred and seventy-one patients were included, of which 139 patients underwent parathyroidectomy, 48 were treated with calcimimetics, and 84 patients received further follow-up without active treatment. In the surgically treated group, a single adenoma was suspected in 127 scans, double adenoma in three scans, and one scan showed evidence of three hyperfunctioning glands. In eight scans, no lesions were visualized. A total of 154 parathyroid glands were surgically removed. The rate of correct detection was calculated at 96% and 90%, on a per patient-based and per lesion-based analysis, respectively. Conclusion This retrospective study in a large cohort shows high detection rates of FCH PET/CT in primary hyperparathyroidism, which is in accordance to literature. The use of FCH PET/CT as a first-line imaging modality in preoperative planning of parathyroid surgery may therefore be a suitable choice.

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Section: Discussionmentioning

confidence: 99%

Parathyroid imaging with 18F-fluorocholine PET/CT as a first-line imaging modality in primary hyperparathyroidism: a retrospective cohort study

et al. 2019

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“…The results of choline PET in combination with magnetic resonance (MR) imaging are promising (90% sensitivity, 100% PPV in the Kluijfhout et al study [24]) but more research and a larger sample size are needed [28,35,50].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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Hyperparathyroidism is a metabolic disorder characterized by the excessive production of the parathyroid hormone. The diagnosis is based on clinical and laboratory data. In most cases the only treatment is surgery and a correct preoperatory localization of the hyperfunctioning parathyroid gland(s) is essential. Currently, ultrasonography combined with [99mTc]Tc-MIBI parathyroid scintigraphy, optionally associated with single photon emission computed tomography/computed tomography (SPECT/CT), represent the standard preoperative imaging. In recent years, a number of studies have evaluated the potential role of choline positron emission tomography (PET) in hyperparathyroidism with promising results. Most of the recent evidence underlined its higher sensitivity and diagnostic accuracy in the localization of hyperfunctioning parathyroid glands. Choline PET has a higher spatial resolution that is useful for the detection of smaller parathyroid glands and it also has shorter examination times and favorable radiation exposure. These are just a few of the aspects that support it to overcome traditional imaging. Moreover, from the preliminary data, the choline uptake mechanism seems to also have an impact on its better performance. For these reasons, if first used as second level imaging in patients with negative or inconclusive traditional imaging results, several authors have supported its use as a first line investigation. This comprehensive overview aims to provide an accurate description of the preliminary results available in the literature about the use of choline PET/CT in hyperparathyroidism and to compare these results with the performance of traditional imaging methods.

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“…Del mismo modo, Scott-Coombes et al en su estudio presentan 111 pacientes doble negativos, y en ellos el calcio y la PTH preoperatoria, y el peso de la glándula eran significativamente menores. Además, la presencia de enfermedad multiglandular era significativamente mayor [19]. ¿Qué hacer cuando las pruebas de localización no son concluyentes?…”

Section: Discusión Pruebas Diagnósticas Y Pruebas De Localización En ...unclassified

“…En suma, algunos autores defienden que en pacientes no operados con doble negativo se debe realizar BNE ante el riesgo de enfermedad multiglandular, y que esta técnica sigue siendo el standard [10,18]. Además, defienden que la BNE sin ioPTH, no es solo igualmente efectiva (tasa de curación equivalente), sino que sería más costeefectiva, porque disminuye el tiempo quirúrgico frente a MIP y el coste económico de la ioPTH [11,19]. Otros concluyen que se puede realizar MIP en pacientes con pruebas discordantes o negativas con similares tasas de curación y menor tiempo quirúrgico, pero con necesidad de emplear ioPTH, y precisando mayor seguimiento por el riesgo de enfermedad multiglandular y el riesgo de recurrencia [19,22].…”

Section: Cirugía Del Hptp Con Pruebas No Concluyentesunclassified

Manejo quirúrgico del hiperparatiroidismo primario con pruebas de localización prequirúrgicas negativas

Toribio-Ruano,

García-Martín,

Sánchez-Mora

et al. 2021

ORL

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Introducción y objetivo: Una vez realizado el diagnóstico de hiperparatiroidismo primario (HPTp), el único tratamiento curativo posible es la paratiroidectomía. Puede llevarse a cabo mediante una exploración cervical bilateral o por medio de una paratiroidectomía mínimamente invasiva (MIP), en la que exclusivamente se explora el compartimento cervical en el que se encuentra la glándula paratiroides sospechosa de causar el HPTp. Los resultados de ambas técnicas son comparables, existiendo una mayor tendencia a realizar MIP cuando en las pruebas de localización de imagen se localiza correctamente la glándula afecta. En el caso de que las pruebas de localización resulten negativas o discordantes el tipo de abordaje quirúrgico es controvertido. Método: Se realizó una revisión sistemática de artículos originales, guías, y documentos de sociedades científicas dedicadas al manejo del hiperparatiroidismo primario que incluían casos con pruebas de localización contradictorias o negativas. Se localizaron 211 estudios y finalmente se seleccionaron 2 revisiones sistemáticas, 20 estudios originales y 4 guías de recomendaciones de sociedades profesionales. Discusión: La recomendación formal de las guías es realizar una BNE en los casos de pruebas de localización negativa. En el resto de la literatura revisada se observó una tendencia creciente de los cirujanos a solicitar pruebas de localización complementarias para intentar una MIP, aunque la mayoría seguían la recomendación de las guías. Algunos autores han reportado tasas de éxito de MIP con medición intraoperatoria de PTH similares a los obtenidos con BNE. Técnicas como el PET-TC con 18F-fluorocolina o 11C-colina, la cirugía radioguiada con gammacámara y la medición intraoperatoria de PTH, son de especial utilidad en el estudio prequirúrgico y como apoyo durante la cirugía de casos con pruebas de localización negativas PALABRAS CLAVE Hiperparatiroidismo primario; Paratiroidectomía; Diagnóstico por imagen;

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The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas

Cited by 20 publications

References 23 publications

Parathyroid imaging with 18F-fluorocholine PET/CT as a first-line imaging modality in primary hyperparathyroidism: a retrospective cohort study

Parathyroid imaging with 18F-fluorocholine PET/CT as a first-line imaging modality in primary hyperparathyroidism: a retrospective cohort study

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

Manejo quirúrgico del hiperparatiroidismo primario con pruebas de localización prequirúrgicas negativas

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