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PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism

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Abstract

Purpose

Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and/or 99mTc-Sestamibi scintigraphy, can be challenging. PET/CT with 18F-Fluorocholine (18F-FCH) might improve the detection of pathologic parathyroid glands. We aimed at comparing the diagnostic performance of 18F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US.

Methods

Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism. All patients underwent high-resolution neck US, dual-phase dual-isotope 99mTc-Pertechnetate/99mTc-Sestamibi scintigraphy, and 18F-FCH-PET/CT.

Results

In the whole patients’ group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for 18F-FCH-PET/CT, and only 15% for 99mTc-Sestamibi scintigraphy. The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were 57 and 70% for neck US, 70 and 71% for 18F-FCH-PET/CT, and 0 and 18% for 99mTc-Sestamibi scintigraphy, respectively. In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology/biochemistry, the correct detection rate was 82% for neck US, 89% for 18F-FCH-PET/CT, and only 17% for 99mTc-Sestamibi scintigraphy.

Conclusions

18F-FCH-PET/CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small.

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Authors and Affiliations

  1. Unit of Nuclear Medicine, ICS Maugeri, 27100, Pavia, Italy

    I. Bossert & G. Trifirò

  2. Unit of Internal Medicine and Endocrinology, ICS Maugeri I.R.C.C.S, University of Pavia, Via S. Maugeri 10, 27100, Pavia, Italy

    S. Chytiris, L. Croce & L. Chiovato

  3. Nuclear Medicine Research Department, Iason, Graz, Austria

    M. Hodolic

  4. Nuclear Medicine Department, Iason, Graz, Austria

    M. Hodolic

  5. Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic

    M. Hodolic

  6. Nuclear Medicine Department, Policlinico S. Orsola Malpighi, University of Bologna, Bologna, Italy

    M. Hodolic

  7. Inter-Universitary Research Center for Sustainable Development (CIRPS), Naples, Italy

    L. Mansi

  8. Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy

    G. Mariani

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  1. I. Bossert
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  2. S. Chytiris
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  4. L. Croce
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Corresponding author

Correspondence to L. Chiovato.

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Conflict of interest

Irene Bossert declares that she has no conflict of interest. Spyridon Chytiris declares that he has no conflict of interest. Marina Hodolic is Clinical Research Supervisor, Iason, Graz, Austria. Laura Croce declares that she has no conflict of interest. Luigi Mansi declares that he has no conflict of interest. Luca Chiovato declares that he has no conflict of interest. Giuliano Mariani declares that he has no conflict of interest. Giuseppe Trifirò declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Bossert, I., Chytiris, S., Hodolic, M. et al. PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism. J Endocrinol Invest 42, 419–426 (2019). https://doi.org/10.1007/s40618-018-0931-z

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  • DOI: https://doi.org/10.1007/s40618-018-0931-z

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