Additional value of integrated 18F-choline PET/4D contrast-enhanced CT in the localization of hyperfunctioning parathyroid glands and correlation with molecular profile
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The localization of hyperfunctioning parathyroid gland(s) (HPTG) in patients with primary hyperparathyroidism (PHPT) with negative or inconclusive first-line imaging is a significant challenge. This study aimed to evaluate the role of integrated 18F-choline PET/4D contrast-enhanced computed tomography (4DCeCT) in these patients, compare its detection rate and sensitivity with those of 18F-choline PET/CT and (4DCeCT), and analyse the association between choline metabolism and morphological, biochemical and molecular parameters of HPTG.
We prospectively enrolled 44 PHPT patients with negative or inconclusive first-line imaging. 18F-Choline PET/CT and 4DCeCT were performed at the same time, and integrated 18F-choline PET/4DCeCT images were obtained after coregistration. Experienced physicians examined the images. The SUVratio and degree of contrast enhancement were recorded for each positive finding. Histopathology, laboratory and multidisciplinary follow-up were used as the standard of reference. Both the detection rates and sensitivities of the three imaging modalities were calculated retrospectively. Immunohistochemistry was performed to evaluate the molecular profile of HPTGs.
18F-Choline PET/4DCeCT was positive in 32 of 44 patients with PHPT (detection rate 72.7%), and 31 of 31 surgically treated patients (sensitivity 100%). These results were significantly (p < 0.05) better than those of 18F-choline PET/CT (56.8% and 80%, respectively) and those of 4DCeCT (54.5 and 74%, respectively). A significant correlation between SUV and calcium level was found. In a multivariate analysis, only calcium level was significantly associated with 18F-choline PET/4DCeCT findings. SUVratio and Ki67 expression were significantly correlated.
Integrated 18F-choline PET/4DCeCT should be considered as an effective tool to detect PHPT in patients with negative or inconclusive first-line imaging. Choline metabolism is correlated with both calcium level and Ki67 expression in HPTG.
KeywordsHyperparathyroidism 18F-Choline Elderly 4DCeCT Molecular profile
This research did not receive any specific grant from any funding agency in the public, commercial or nonprofit sector.
Compliance with ethical standards
Conflicts of interest
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 principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.Singh Ospina NM, Rodriguez-Gutierrez R, Maraka S, Espinosa de Ycaza AE, Jasim S, Castaneda-Guarderas A, et al. Outcomes of parathyroidectomy in patients with primary hyperparathyroidism: a systematic review and meta-analysis. World J Surg. 2016;40(10):2359–77. https://doi.org/10.1007/s00268-016-3514-1.CrossRefGoogle Scholar
- 5.Treglia G, Sadeghi R, Schalin-Jäntti C, Caldarella C, Ceriani L, Giovanella L, et al. Detection rate of (99m) Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: a meta-analysis. Head Neck. 2016;381:E2159–72.CrossRefGoogle Scholar
- 8.Treglia G, Trimboli P, Huellner M, Giovanella L. Imaging in primary hyperparathyroidism: focus on the evidence-based diagnostic performance of different methods. Minerva Endocrinol. 2018;43(2):133–43.Google Scholar
- 11.Mekel M, Linder R, Bishara B, Kluger Y, Bar-On O, Fischer D. 4-dimensional computed tomography for localization of parathyroid adenoma. Harefuah. 2013;152:710–2.Google Scholar
- 17.Michaud L, Burgess A, Huchet V, Lefèvre M, Tassart M, Ohnona J, et al. Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism? J Clin Endocrinol Metab. 2014;99:4531–6.CrossRefGoogle Scholar
- 20.Michaud L, Balogova S, Burgess A, Ohnona J, Huchet V, Kerrou K, et al. A pilot comparison of 18f-fluorocholine PET/CT, ultrasonography and 123i/99mtc-sestamibi dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: influence of thyroid anomalies. Medicine (Baltimore). 2015;94:e1701.CrossRefGoogle Scholar
- 22.Grimaldi S, Young J, Kamenicky P, Hartl D, Terroir M, Leboulleux S, et al. Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of (18)F-fluorocholine PET/CT. Eur J Nucl Med Mol Imaging. 2018;45(10):1772–80. https://doi.org/10.1007/s00259-018-4018-z.CrossRefGoogle Scholar
- 23.Taywade SK, Damle NA, Behera A, Devasenathipathy K, Bal C, Tripathi M, et al. Comparison of 18F-fluorocholine positron emission tomography/computed tomography and four-dimensional computed tomography in the preoperative localization of parathyroid adenomas – initial results. Indian J Endocrinol Metab. 2017;21(3):399–403.CrossRefGoogle Scholar
- 25.Beheshti M, Hehenwarter L, Paymani Z, Rendl G, Imamovic L, Rettenbacher R, et al. (18)F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with (99m)Tc-MIBI or (99m)Tc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging. 2018;45(10):1762–71. https://doi.org/10.1007/s00259-018-3980-9.CrossRefGoogle Scholar
- 26.Lloyd RV, Osamura RY, Kloppel G, Rosai J. WHO Classification of Tumours of Endocrine Organs: WHO Classification of Tumours, 4th Edition, Volume 10. Lyon: International Agency for Research on Cancer, 2017.Google Scholar
- 27.Krakauer M, Wieslander B, Myschetzky PS, Lundstrøm A, Bacher T, Sørensen CH, et al. A prospective comparative study of parathyroid dual-phase scintigraphy, dual-isotope subtraction scintigraphy, D-CT, and ultrasonography in primary hyperparathyroidism. Clin Nucl Med. 2016;41:93–100.CrossRefGoogle Scholar
- 28.Lumachi F, Zucchetta P, Marzola MC, Boccagni P, Angelini F, Bui F, et al. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol. 2000;143:755–60.CrossRefGoogle Scholar
- 31.Chen CC, Skarulis MC, Fraker DL, Alexander R, Marx SJ, Spiegel AM. Technetium-99m-sestamibi imaging before reoperation for primary hyperparathyroidism. J Nucl Med. 1995;36:2186–91.Google Scholar
- 32.Kluijfhout WP, Vorselaars WM, van den Berk SA, Vriens MR, Borel Rinkes IH, Valk GD, et al. Fluorine-18 fluorocholine PET-CT localizes hyperparathyroidism in patients with inconclusive conventional imaging: a multicenter study from the Netherlands. Nucl Med Commun. 2016;37:1246–52.CrossRefGoogle Scholar
- 33.Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2018. https://doi.org/10.1007/s00259-018-4123-z.Google Scholar