Usefulness of¹⁸F-Fluorocholine Positron Emission Tomography–Computed Tomography in Locating Lesions in Hyperparathyroidism

Abstract

Identifying parathyroid glands correctly before a surgical procedure is essential to perform minimally invasive surgery. First-line tests with discordant or negative results underscore the need for more accurate imaging tests, thus decreasing the requirement for bilateral neck exploration or reintervention.OBJECTIVE To review the available evidence to determine positive predictive value, negative predictive value, sensitivity, and specificity in clinical cases in which 18 F-fluorocholine positron emission tomography-computed tomography (PET/CT) could be useful as a method to locate the lesions, and the benefits and controversial aspects of the method.EVIDENCE REVIEW A search was conducted using the PubMed Central and Cochrane Library databases for studies published in English from July 26, 2014, to November 30, 2018, using the search terms 18 choline, 18F choline, 18F-choline, 18 fluorocholine PET CT, hyperparathyroidism, primary hyperparathyroidism, secondary hyperparathyroidism, tertiary hyperparathyroidism, persistent hyperparathyroidism, recurrent hyperparathyroidism, ectopic hyperparathyroidism, and parathyroid adenoma. Other inclusion criteria were reporting at least 1 of the following measurements: negative or positive predictive value, sensitivity, and specificity of 18 F-fluorocholine PET/CT in the diagnosis of hyperparathyroidism (HPT). Exclusion criteria were language other than English, use of a tracer other than 18 F-fluorocholine, reports of a single case, and studies not related to HPT. The Oxford Centre classifications for levels of evidence were used.FINDINGS Sixteen studies fulfilled the inclusion criteria, comprising a total of 619 patients. Selected studies included 10 prospective cohort studies, 5 retrospective cohort studies, and 1 case series. Of the subtypes of HPT diagnosed using 18 F-fluorocholine PET/CT, 579 were primary HPT, 22 were secondary HPT, 1 was tertiary HPT, and 7 were associated with multiple endocrine neoplasia type I. Pathologically, the neoplasms comprised 459 adenomas, 59 hyperplasia, and 19 double adenomas.CONCLUSIONS AND RELEVANCE 18 F-fluorcholine PET/CT may be indicated when results of first-line tests are negative or discordant and in challenging clinical situations where locating the source of HPT is difficult.

18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature

“…A number of systematic reviews and meta-analyses on FCH PET/CT have been published in the last 2 years (Table 4) (Kim et al [38]; Treglia et al [39]; Boccalatte et al [40]; Broos et al [33]). In all cases, FCH PET/CT had an optimal performance in identifying benign parathyroid lesions.…”

“…Unfortunately, the paucity of data on PET/MRI in this field prevents us from drawing any further conclusions about the diagnostic potential of this technique. Per lesion-based analysis -Choline PET has a pooled sensitivity of 90% and a pooled specificity of 94% for the identification of HPT Treglia et al [39] 2019 Yes 18 No Radiolabeled Choline PET has a pooled sensitivity of 95% and a pooled PPV of 91% for the identification of HPT Boccalatte et al [40] 2019 No 15 No 18F-Choline PET provides a high accuracy, sensitivity and specificity for the identification of HPT Broos et al [33] 2019 No 11 No High detection rate of choline PET/CT in preoperative localization of hyperfunctioning parathyroid glands in patients with primary HPT…”

Intrathyroidal parathyroid adenoma mimicking thyroid cancer

“…In our case the 99m Tc sestamibi scan did not assist in the diagnosis prob-ably due to its cystic morphology. The 18F-fluorocholine PET/CT and the 11C-methionine PET/CT have shown excellent sensitivity for parathyroid lesions and could be of diagnostic assistance when available [14,15].…”

Lokalisationsdiagnostik von Nebenschilddrüsenadenomen mittels PET/CT

“…Dieses Untersuchungsverfahren zeichnet sich durch eine hohe Sensitivität und somit eine sehr hohe Detektionsrate bei gleichzeitig geringer Strahlenexposition aus. 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.…”