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Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas

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Abstract

Objective

To compare detectability of hyperfunctioning parathyroid tissue (HPT) by digital and analog 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT.

Materials and methods

Thirty-three patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT were prospectively included. All patients accepted to be scanned by digital and analog PET/CT in the same imaging session after a single injection of 18F-fluorocholine. Three nuclear medicine physicians evaluated the digital and analog PET/CT datasets to assess the detection rate of HPT. Maximum standard uptake values (SUVmax) of HPT and locoregional lymph nodes were measured in both systems.

Results

HPT was detected in 30/33 patients by the digital system, whereas it was detected in 22/33 patients by the analog system (p < 0.01). Moreover, in 21 of these 33 patients, both systems detected one focal 18F-fluorocholine uptake, and in one patient the digital system detected two foci. Histopathology demonstrated HPT in 32 patients and it was inconclusive in one patient. The digital PET/CT detected HPT in 29 of the 32 patients, and the analog system in 22 of the 32 (p < 0.01). All HPT suspected lesions resected and detected only by the digital system (n = 8) were < 10 mm (7.5 ± 1.3 mm), while those detected by both systems (n = 22) were > 10 mm (13 ± 3.8 mm). SUVmax of HPT lesions was significantly higher than SUVmax of locoregional lymph node independently of the PET/CT system used (4.5 ± 1.9 vs. 2.9 ± 1.3, p < 0.0001).

Conclusions

Digital PET/CT offers superior performance over analog system in patients with suspected HPT and previous negative/inconclusive imaging examinations, particularly in sub-centimeter lesions. SUVmax can help in the differentiation between HTP and locoregional lymph nodes.

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Author information

Correspondence to Diego Alfonso López-Mora.

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Conflict of interest

Diego Alfonso López-Mora declares that he has no conflict of interest. Marina Sizova declares that she has no conflict of interest. Montserrat Estorch declares that she has no conflict of interest. Albert Flotats declares that he has no conflict of interest. Valle Camacho declares that she has no conflict of interest. Alejandro Fernández declares that he has no conflict of interest. Safae Abouzian declares that she has no conflict of interest. Francisco Fuentes-Ocampo declares that he has no conflict of interest. José Ignacio Pérez Garcia declares that he has no conflict of interest. Anna Isabel Chico Ballesteros declares that she has no conflict of interest. Joan Duch declares that he has no conflict of interest. Anna Domènech declares that she has no conflict of interest. Antonio Moral Duarte declares that he has no conflict of interest. Ignasi Carrio has received research grants from Philips Healthcare. Ignasi Carrio has received a speaker honorarium from Philips Healthcare.

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Supplementary Table

Biochemical and clinical characteristics of each patients with primary hyperparathyroidism and negative or inconclusive 99mTc-MIBI parathyroid scintigraphy-SPECT/CT. (JPG 256 kb)

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López-Mora, D.A., Sizova, M., Estorch, M. et al. Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas. Eur J Nucl Med Mol Imaging (2020) doi:10.1007/s00259-020-04680-7

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Keywords

  • 18F-fluorocholine
  • Digital PET/CT
  • Analog PET/CT
  • 99mTc-MIBI scintigraphy
  • Primary hyperparathyroidism
  • Parathyroid adenoma