18F-NaF-PET/CT in patients with primary hyperparathyroidism and brown tumors
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.
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).
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.
KeywordsBrown tumor Primary hyperparathyroidism PET/CT Sodium fluoride Endocrinology
Sodium fluoride labeled with fluorine-18
Fluorodeoxyglucose labeled with fluorine-18
Bone mineral density
Dual energy X-ray absorptiometry
Field of view
Glomerular filtration rate
Hungry bone syndrome
Osteitis fibrosa cystica
Maximum standardized uptake value
Total metabolically active bone volume per patient
Volume of interest
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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.
Compliance with ethical standards
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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