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18F-Fluorocholine PET/CT and Parathyroid 4D Computed Tomography for Primary Hyperparathyroidism: The Challenge of Reoperative Patients

  • Coralie Amadou
  • Géraldine Bera
  • Malek Ezziane
  • Linda Chami
  • Thierry Delbot
  • Agnès Rouxel
  • Monique Leban
  • Genevieve Herve
  • Fabrice Menegaux
  • Laurence Leenhardt
  • Aurélie Kas
  • Christophe Trésallet
  • Cécile Ghander
  • Charlotte Lussey-LepoutreEmail author
Original Scientific Report

Abstract

Background

To evaluate FCH-PET/CT and parathyroid 4D-CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery.

Methods

Medical records of all patients referred for a FCH-PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc-99m-sestaMIBI scintigraphy, and furthermore, some patients had 4D-CT. Gold standard was defined by pathological findings and/or US-guided fine-needle aspiration with PTH level measurement in the washing liquid.

Results

Twenty-nine patients were included in this retrospective study. FCH-PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D-CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH-PET/CT guidance. US and Tc-99m-sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH-PET/CT foci in 27 patients. On a per-lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH-PET/CT, 75%, 40%, 80% and 33% for 4D-CT. On a per-patient analysis, sensitivity was 85% for FCH-PET/CT and 63% for 4D-CT. FCH-PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc-99m-sestaMIBI scintigraphy result, with a global cure rate of 73%.

Conclusion

FCH-PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D-CT appears as a confirmatory imaging modality.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest for this study.

Supplementary material

268_2019_4910_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 17 kb)

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Coralie Amadou
    • 1
  • Géraldine Bera
    • 2
    • 3
  • Malek Ezziane
    • 4
  • Linda Chami
    • 3
    • 4
  • Thierry Delbot
    • 2
  • Agnès Rouxel
    • 2
  • Monique Leban
    • 5
  • Genevieve Herve
    • 6
  • Fabrice Menegaux
    • 7
  • Laurence Leenhardt
    • 1
    • 3
  • Aurélie Kas
    • 2
    • 3
  • Christophe Trésallet
    • 7
    • 8
  • Cécile Ghander
    • 1
  • Charlotte Lussey-Lepoutre
    • 2
    • 9
    Email author
  1. 1.Department of Thyroid and Endocrine Tumours, Pitié-Salpêtrière HospitalSorbonne UniversityParisFrance
  2. 2.Department of Nuclear Medicine, Pitié-Salpêtrière HospitalSorbonne UniversityParisFrance
  3. 3.Laboratoire d’imagerie biomedicale (LIB), INSERM U1146Sorbonne UniversityParisFrance
  4. 4.Department of Radiology, Pitié-Salpêtrière HospitalSorbonne UniversityParisFrance
  5. 5.Laboratory of Endocrine Biochemistry, Pitié-Salpêtrière HospitalSorbonne UniversityParisFrance
  6. 6.Department of Histopathology, Pitié-Salpêtrière HospitalSorbonne UniversityParisFrance
  7. 7.Department of Endocrine Surgery, Pitié-Salpêtrière HospitalSorbonne UniversityParisFrance
  8. 8.Laboratoire d’imagerie fonctionnelle (LIF), INSERM U678Sorbonne UniversityParisFrance
  9. 9.INSERM, UMR970Paris-Cardiovascular Research CenterParisFrance

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