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Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Previous studies have shown high sensitivity of positron emission tomography (PET) with 11C-methionine in the pre-operative localisation of parathyroid adenoma and hyperplasia. Nonetheless, in secondary and tertiary hyperparathyroidism (HPT) and in patients with recurrent disease, pre-operative localisation of adenomatous (PTA) or hyperplastic tissue is still a problem with all available methods. The aim of this study was to define the optimal imaging protocol and to compare the diagnostic value of 11C-methionine PET and 99mTc-methoxyisobutylisonitrile (MIBI) single-photon emission computed tomography (SPECT): in particular, we wished to define the benefit of 11C-methionine in those patients with inconclusive or negative conventional imaging.

Methods

Thirty highly pre-selected patients with HPT were enrolled. Sixteen patients had primary HPT, 12 patients had secondary HPT, and two patients had recurrences of parathyroid carcinomas. All patients had ultrasound of the neck, dual-phase scintigraphy with 99mTc-MIBI and PET with 11C-methionine. SUVparathyroid/SUVcervical soft tissue (target-to-background) and SUVparathyroid tissue/SUVthyroid tissue (target-to-non-target) ratios were calculated. After surgery, histology of specimens was obtained in all patients but one.

Results

In 12 patients with secondary or tertiary HPT, 36 hyperplastic parathyroid glands were histologically verified. Twenty-five of 36 lesions (69%) were detected with 11C-methionine PET and 17 (47%) with 99mTc-MIBI scintigraphy. PET studies were positive in 17/18 (94%) cases in which HPT was related to adenomas or carcinomas. 99mTc-MIBI scintigraphy/SPECT yielded pathological lesions in 9/18 cases (50%). All eight atypical localisations of parathyroid glands were detected with PET but only six of the eight were detected with 99mTc-MIBI scintigraphy/SPECT. In 10/11 patients with recurrent HPT and non-diagnostic scintigraphy/SPECT, hyperfunctional parathyroid tissue was identified with 11C-methionine PET. The highest SUVparathyroid/SUVcervical soft tissue ratio was found 10 min, and the highest SUVparathyroid tissue/SUVthyroid tissue ratio 40 min post injection. In three patients clear delineation of hyperfunctional tissue was only achieved after 40 min post injection.

Conclusion

11C-methionine PET is a clinically useful method in highly pre-selected patients with recurrent primary HPT as well as in secondary and tertiary HPT if ultrasound and 99mTc-MIBI SPECT are inconclusive or negative. PET imaging of atypical PTA localisations is more accurate than conventional scintigraphy. In order to achieve optimal contrast of parathyroid glands versus thyroid tissue and adjacent soft tissue, imaging at both 10 min and 40 min is recommended.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hannover University Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    D. Otto, A. R. Boerner, M. Hofmann, T. Brunkhorst, G. J. Meyer, T. Petrich & W. H. Knapp

  2. Department of Visceral and Transplant Surgery, Hannover University Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany

    G. F. Scheumann

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  1. D. Otto
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  2. A. R. Boerner
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Correspondence to A. R. Boerner.

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Otto, D., Boerner, A.R., Hofmann, M. et al. Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET. Eur J Nucl Med Mol Imaging 31, 1405–1412 (2004). https://doi.org/10.1007/s00259-004-1610-1

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  • DOI: https://doi.org/10.1007/s00259-004-1610-1

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