European Radiology

, Volume 28, Issue 6, pp 2700–2707 | Cite as

Benefit of 18F-fluorocholine PET imaging in parathyroid surgery

  • G. F. HuberEmail author
  • M. Hüllner
  • C. Schmid
  • A. Brunner
  • B. Sah
  • D. Vetter
  • P. A. Kaufmann
  • G. K. von Schulthess
Nuclear Medicine



To assess the additional diagnostic value of 18F-fluorocholine PET imaging in preoperative localization of pathologic parathyroid glands in clinically manifest hyperparathyroidism in case of negative or conflicting ultrasound and scintigraphy results.


A retrospective, single-institution study of 26 patients diagnosed with hyperparathyroidism. In cases where ultrasound and scintigraphy failed to detect the location of an adenoma in order to allow a focused surgical approach, an additional 18F-fluorocholine PET scan was performed and its results were compared with the intraoperative findings.


A total of 26 patients underwent 18F-fluorocholine PET/CT (n = 11) or PET/MRI (n = 15). Adenomas were detected in 25 patients (96.2%). All patients underwent surgery, and the location predicted by PET hybrid imaging was confirmed intraoperatively by frozen section and adequate parathyroid hormone drop after removal. None of the patients needed revision surgery during follow-up.


These results demonstrate that 18F-fluorocholine PET imaging is a highly accurate method to detect parathyroid adenomas even in case of previous localization failure by other imaging examinations.

Key Points

With 18 F-fluorocholine PET imaging, parathyroid adenomas could be detected in 96.2%.

18 F-fluorocholine imaging is a highly accurate method to detect parathyroid adenomas.

We encourage its use, where ultrasound fails to detect an adenoma.


Hyperparathyroidism Choline PET/CT PET/MR Minimally invasive surgical procedures 



The authors state that this work has not received any funding.

Compliance with ethical standards

FCh-PET in patients with HPT is an approved clinical imaging procedure in our country, and is therefore partly reimbursed by health insurance. Permission for conducting our study was obtained by the ethical committee responsible for our hospital (no. 2016-01616). Due to the retrospective nature of our study, written general informed consent of patients was deemed sufficient by the institutional review board for inclusion into the study. Patients who refused to give signed informed consent were not included into the study. All co-authors mentioned above disclose no potential conflicts of interest.


The scientific guarantor of this publication is Gerhard Huber.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• observational

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • G. F. Huber
    • 1
    Email author
  • M. Hüllner
    • 2
  • C. Schmid
    • 3
  • A. Brunner
    • 3
  • B. Sah
    • 2
    • 4
  • D. Vetter
    • 5
  • P. A. Kaufmann
    • 2
  • G. K. von Schulthess
    • 2
  1. 1.Department of Otorhinolaryngology, Head & Neck SurgeryUniversity Hospital ZurichZurichSwitzerland
  2. 2.Department of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland
  3. 3.Department of Endocrinology, DiabetologyUniversity Hospital ZurichZurichSwitzerland
  4. 4.Department of Diagnostic and Interventional RadiologyUniversity Hospital ZurichZurichSwitzerland
  5. 5.Department of General SurgeryUniversity Hospital ZurichZurichSwitzerland

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