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18F-NaF-PET/CT in patients with primary hyperparathyroidism and brown tumors

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Journal of Bone and Mineral Metabolism Aims and scope Submit manuscript

Abstract

Introduction

Brown tumors (BT) are non-neoplastic bone lesions infrequently occurring in patients with long-standing severe hyperparathyroidism (HPT). BT may be identified and characterized using 18-F-sodium fluoride-positron-emission-tomography/computed tomography (18F-NaF-PET/CT). We present a retrospective series of eight primary hyperparathyroidism (pHPT) patients with BT imaged with 18F-NaF-PET/CT.

Materials and methods

Imaging assessment included location, diameter, maximum standardized uptake value (SUVmax), metabolically active lesion volume (PETvol) of BT, total metabolically active bone volume (TMBvol) per patient and several computed tomography (CT) features of BT. Where appropriate, we analyzed the association between characteristic features of BT in 18F-NaF-PET/CT, histopathology, clinical symptomatology and laboratory parameters.

Results

In our cohort of 8 patients (median age, 49 years, range, 26–73), 72 BT were found. The mean PETvol of BT was 89.48 cm3 ± 122.81 cm3 and the mean SUVmax was 17.5 ± 7.8. The total PETvol of BT per patient correlated positively with serum calcium (r = 0.810, p = 0.015), and negatively with glomerular filtration rate (GFR) (r = − 0.762, p = 0.028). TMBvol correlated significantly with serum PTH (r = 0.810, p = 0.015), alkaline phosphatase (r = 0.762, p = 0.028), and duration of postoperative hospitalization (r = 0.826, p = 0.011, 24.3 days ± 19.8 days).

Conclusion

18F-NaF-PET/CT is a valuable non-invasive whole-body imaging technique for the assessment of patients with pHPT and BT. TMBvol is associated with PTH and alkaline phosphatase, and the requirement for intense postoperative calcium substitution, which determines the duration of hospitalization.

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Abbreviations

18F-NaF:

Sodium fluoride labeled with fluorine-18

25-OH-ViD:

25-Hydroxy-vitamin-D3

18F-FDG:

Fluorodeoxyglucose labeled with fluorine-18

BMD:

Bone mineral density

BT:

Brown tumors

CT:

Computed tomography

DXA:

Dual energy X-ray absorptiometry

FOV:

Field of view

GFR:

Glomerular filtration rate

HBS:

Hungry bone syndrome

MBq:

Megabecquerel

OFC:

Osteitis fibrosa cystica

PET/CT:

Positron-emission-tomography/computed tomography

PETvol :

Metabolic volume

pHPT:

Primary hyperparathyroidism

PTH:

Parathyroid hormone

SD:

Standard deviation

sHPT:

Secondary hyperparathyroidism

SUVmax :

Maximum standardized uptake value

TMBvol :

Total metabolically active bone volume per patient

VOI:

Volume of interest

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Endocrinology, University Hospital Zurich/University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    Carmen Graf, Oliver Tschopp & Christoph Schmid

  2. Department of Nuclear Medicine, University Hospital Zurich/University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    Martin Huellner

  3. Institute of Pathology and Molecular Pathology, University Hospital Zurich/University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    Beata Bode-Lesniewska

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Contributions

Study design: C.G., M.H., O.T., C.S. Study conduct: C.S. Data collection: C.G., M.H., B.B., C.S. Data analysis: C.G., M.H., C.S. Data interpretation: C.G., M.H., O.T., B.B., C.S. Drafting manuscript: C. G., M.H. Revising manuscript content: C.G., M.H., O.T., B.B., C.S. Approving final version of manuscript: C.G., M.H., O.T., B.B., C.S. C.G., M.H. and C.S. take responsibility for the integrity of the data analysis.

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Correspondence to Martin Huellner.

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Conflict of interest

MH is a recipient of IIS grants, institutional grants, and speaker’s fees from GE Healthcare, and has received funding from the Alfred and Annemarie von Sick grant for translational and clinical cardiac and oncological research. All other authors have no conflict of interest.

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Graf, C., Huellner, M., Tschopp, O. et al. 18F-NaF-PET/CT in patients with primary hyperparathyroidism and brown tumors. J Bone Miner Metab 38, 299–309 (2020). https://doi.org/10.1007/s00774-019-01059-z

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