European Archives of Oto-Rhino-Laryngology

, Volume 276, Issue 5, pp 1509–1516 | Cite as

The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas

  • Avi Khafif
  • Muhamed MasalhaEmail author
  • Roee Landsberg
  • Liran Domachevsky
  • Hanna Bernstine
  • David Groshar
  • Ofer Azoulay
  • Yehudit Lockman
Head & Neck



Preoperative localization of a parathyroid adenoma is usually obtained by the combination of ultrasound and scintigraphy with technetium-99m methoxyisobutylisonitrile. We evaluated the role of F18-fluorocholine in neck positron emission tomography/magnetic resonance imaging as a novel tool for localizing parathyroid adenomas.


Patients with primary hyperparathyroidism were recruited from February 2016 to August 2017 and F18-fluorocholine positron emission tomography/magnetic resonance imaging was performed to localize the parathyroid adenoma prior to surgery. We compared sensitivity and accuracy of this modality with ultrasound and technetium-99m methoxyisobutylisonitrile scintigraphy using the verified location of the diseased parathyroid as found in surgery.


Nineteen patients were included in our study (15 women and 4 men, mean age 60.5 ± 9.8 years). Positron emission tomography/magnetic resonance imaging precisely localized the pathologic parathyroid gland in 16/19 cases (84.2%) and predicted the diseased side in 19/19 cases (100%). Ultrasound and technetium 99 m methoxyisobutylisonitrile sestamibi scintigraphy predicted the location of the parathyroid adenoma in 16/19 (84.2%) and 14/19 (74%), respectively. In 3/19 patients, positron emission tomography/magnetic resonance imaging localized the parathyroid adenoma where as other modalities failed. Positron emission tomography/magnetic resonance imaging was more accurate when compared to each modality separately (p < 0.001, p = 0.017), however, when comparing the three modalities all together no differences were found (p = 0.506).


Localizing parathyroid adenomas with F18-fluorocholine positron emission tomography/magnetic resonance imaging may be a promising secondary imaging modality.


Positron emission tomography/magnetic resonance imaging Parathyroid localization Adenoma Ultrasound Technetium 99 m sestamibi 



Nyall R. London Jr. MD, PhD. Ohio State University—College of Medicine. Department of Otolaryngology—Head and Neck Surgery. Columbus, Ohio 43210. Performed grammar and English language review.



Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

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 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.A. R. M. Center of Otolaryngology, Head and Neck Surgery, Department of Otolaryngology, Head and Neck Surgery, Assuta Medical Center, Faculty of MedicineTel Aviv. Affiliated with Ben Gurion UniversityBeershebaIsrael
  2. 2.Department of Nuclear Medicine, Assuta Medical Center, Faculty of MedicineTel Aviv. Affiliated with Ben Gurion UniversityBeershebaIsrael
  3. 3.Department of Otolaryngology, Head and Neck Surgery, Emeq Medical CenterTechnion UniversityHaifaIsrael

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