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18F-fluorocholine PET/MRI versus ultrasound and sestamibi for the localization of parathyroid adenomas

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Abstract

Purpose

Accurate preoperative localization is imperative to facilitate a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). This study aims to compare the diagnostic value of standard-of-care localization techniques (ultrasound [US] and 99mTechnetium (99mTc) -sestamibi scintigraphy) to [F-18]-fluorocholine positron emission tomography/magnetic resonance imaging (FCH-PET/MRI) to determine the additional clinical usefulness of PET/MRI in a Canadian cohort.

Methods

We conducted a prospective, appropriately powered, study to compare the diagnostic value of -FCH PET/MRI to that of the US and 99mTc-sestamibi scintigraphy for localization of parathyroid adenomas in a patient with pHPT. The primary outcome was the per-lesion sensitivity and positive predictive value (PPV) of FCH-PET/MRI, US, and 99mTc-sestamibi scintigraphy. Intraoperative surgeon localization, parathormone levels, and histopathological findings were used as reference standards.

Results

Forty-one patients underwent FCH-PET/MRI of which 36 patients had parathyroidectomy. In these 36 patients, 41 parathyroid lesions were histologically confirmed as adenomas or hyperplastic glands. Per-lesion sensitivity of FCH-PET/MRI was 82.9% and of US and 99mTc-sestamibi scintigraphy combined at 50.0%, respectively. The sensitivity of FCH-PET/MRI was superior to that of US and 99mTc-sestamibi scintigraphy (p = 0.002). In the 19 patients in whom both US and 99mTc-sestamibi scintigraphy were negative, PET/MRI correctly identified the parathyroid adenoma in 13 patients (68%).

Conclusions

FCH-PET/MRI is a highly accurate imaging modality for localization of parathyroid adenomas in a tertiary center in North America. It is a superior functional imaging modality to 99mTc-sestamibi scintigraphy alone and more sensitive for localization of parathyroid lesions than US and 99mTc-sestamibi scintigraphy combined. This imaging modality could become the most valuable preoperative localization study given its superior performance in localizing parathyroid adenomas.

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Data availability

The principal investigators (JDP and PVH) had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors acknowledge Dr. A. Kohan for his help with Fig. 2.

Author information

Author notes

  1. JD Pasternak and P. Veit-Haibach contributed equally and shared last authorship.

Authors and Affiliations

  1. University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands

    ME Noltes, P Bongers & S. Kruijff

  2. University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands

    ME Noltes, A. H. Brouwers & S. Kruijff

  3. Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada

    ME Noltes, L Rotstein, WP Kluijfhout, P Bongers & JD Pasternak

  4. Department of Otolaryngology-Head and Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada

    A Eskander

  5. Toronto Joint Department Medical Imaging, University Health Network, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

    U. Metser & P. Veit-Haibach

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Contributions

Study conception and design: M.E.N. L.R., W.P.K., P.B., U.M., J.D.P., P.V.H. Acquisition of data: M.E.N., J.D.P., P.V.H. Analysis and interpretation of data: all authors. Drafting of the manuscript: M.E.N., J.D.P, P.V.H. Critical revision of the manuscript: all authors. All authors contributed to data collection and analysis, drafting of the manuscript, and approved the submitted version.

Corresponding author

Correspondence to JD Pasternak.

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Noltes, M., Rotstein, L., Eskander, A. et al. 18F-fluorocholine PET/MRI versus ultrasound and sestamibi for the localization of parathyroid adenomas. Langenbecks Arch Surg 408, 155 (2023). https://doi.org/10.1007/s00423-023-02893-6

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