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Head-to-head comparison among 18F-choline PET/CT, 4D contrast-enhanced CT, and 18F-choline PET/4D contrast-enhanced CT in the detection of hyperfunctioning parathyroid glands: a systematic review and meta-analysis

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Abstract

Introduction

In primary hyperparathyroidism (PHPT), the localization of hyperfunctioning parathyroid gland (HPTG) allows tailored surgery. Although Four-Dimensional Contrast-enhanced Computed Tomography (4DCeCT) and 18F-choline Positron Emission Tomography/Computed Tomography (PET/CT) are reported to be promising second-line imaging procedures, no meta-analysis of their comparison exists.

Design

we conducted a systematic review and meta-analysis to find original papers reporting the head-to-head comparison of 4DCeCT, 18F-choline PET/CT and integrated 18F-choline-PET/4DCeCT.

Methods

this systematic review was conducted according to PRISMA. PubMed, CENTRAL, Scopus, and Web of Science were searched until January 2021. Studies comparing the ability of 4DCeCT, 18F-choline PET/CT and 18F-choline PET/4DCeCT to identify HPTG in patients with PHPT were selected. A per patient-based analysis of the three procedures was conducted in all patients (detection rate, DR) and in those with histologically confirmed HPTG (sensitivity).

Results

Of the 78 records identified, five articles (153 PHPT patients) published between January the 1st, 2018 and January the 31st, 2021 were included. The pooled DR of 18F-choline PET/CT, 4DCeCT and 18F-choline PET/4DCeCT was 0.86, 0.69, and 0.86, respectively, while their pooled sensitivity was 0.89, 0.77 and 0.93, respectively. The analysis of pooled discrepancy showed that the sensitivity of 18F-choline PET/CT and 18F-choline PET/4DCeCT was higher than that of 4DCeCT by 0.11 and 0.13, respectively, the sensitivity of 18F-choline PET/4DCeCT being 0.06 higher than that of 18F-Choline PET/CT.

Conclusions

This meta-analysis suggests that the sensitivity of 18F-choline PET/CT and 18F-choline PET/4DCeCT is higher than that of 4DCeCT, while only a slight difference was observed between 18F-choline PET/CT and 18F-choline PET/4DCeCT.

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Author contributions

A.P.: contributed to the conception of the study, acquired and analyzed data, drafting the manuscript. G.B.: contributed to the conception of the study, analyzed data, drafting the manuscript. L.B.: contributed to the acquisition and analysis of data. C.C.: contributed to the acquisition and analysis of data. M.M.: contributed to the acquisition and analysis of data. L.B.: contributed to design of the study and revised the manuscript. C.C.: contributed to the acquisition and analysis of data. M.U. contributed to the acquisition and analysis of data. F.F.: contributed to design of the study and revised the manuscript. P.T. revised the manuscript critically for important intellectual content.

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Authors and Affiliations

  1. Nuclear Medicine Department, Ente Ospedaliero “Ospedali Galliera”, Genoa, Italy

    Arnoldo Piccardo, Gianluca Bottoni & Martina Ugolini

  2. Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Luis Alejandro Boccalatte

  3. Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Chiara Camponovo

  4. Department of Endocrinology, Metabolism and Nuclear Medicine/PET-CT, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Martina Musumeci & Carlos Collaud

  5. Radiology Department, Ente Ospedaliero “Ospedali Galliera”, Genoa, Italy

    Lorenzo Bacigalupo

  6. Nuclear Medicine Department, Humanitas Research Hospital—IRCCS, Rozzano, Milan, Italy

    Francesco Fiz

  7. Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland

    Pierpaolo Trimboli

  8. Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Pierpaolo Trimboli

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  1. Arnoldo Piccardo
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Correspondence to Francesco Fiz.

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Piccardo, A., Bottoni, G., Boccalatte, L.A. et al. Head-to-head comparison among 18F-choline PET/CT, 4D contrast-enhanced CT, and 18F-choline PET/4D contrast-enhanced CT in the detection of hyperfunctioning parathyroid glands: a systematic review and meta-analysis. Endocrine 74, 404–412 (2021). https://doi.org/10.1007/s12020-021-02798-8

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