Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis

  • Giorgio TregliaEmail author
  • Arnoldo Piccardo
  • Alessio Imperiale
  • Klaus Strobel
  • Philipp A. Kaufmann
  • John O. Prior
  • Luca Giovanella
Original Article



Hyperparathyroidism (HPT) is a common endocrine disorder caused by hyperfunctioning parathyroid glands (HP). The correct detection and localization of HP is challenging but crucial, as it may guide surgical treatment, particularly in patients with primary HPT. There is a growing body of data regarding the role of radiolabelled choline positron emission tomography (PET) in this setting. Therefore, we performed a systematic review and meta-analysis of the diagnostic performance of this method in detecting HP in patients with HPT.


This systematic review and meta-analysis was carried out according to PRISMA guidelines. A comprehensive computer literature search of PubMed/MEDLINE, EMBASE and Cochrane Library databases for studies published through May 2018 was performed using the following search algorithm: (a) “choline” or “fluorocholine” or “F-choline” or “C-choline” or “FCH” or “CH” or “FECH” or “FMCH” and (b) “PET” or “positron emission tomography” and (c) “parathyroid” or “hyperparathyroidism”. The diagnostic performance of radiolabelled choline PET was expressed as sensitivity and positive predictive value (PPV) on a per-patient and per-lesion basis and as detection rate (DR) on a per-patient basis, with pooled proportion and 95% confidence interval (95% CI) obtained using a random-effects model.


Eighteen studies were included in the systematic review. Fourteen articles (517 patients) were selected for the meta-analysis. The meta-analysis provided the following results on a per-patient analysis analysis: sensitivity 95% (95% CI: 92–97%), PPV 97% (95% CI: 95–98%) and DR 91% (95% CI: 87–94%). On a per-lesion analysis, pooled sensitivity and PPV were 92% (95% CI: 88–96) and 92% (95% CI: 89–95%), respectively. No significant heterogeneity was found among the selected studies.


Radiolabelled choline PET demonstrated excellent diagnostic performance in detecting HP in patients with HPT. Large multicentre studies and cost-effectiveness analyses are needed to better define the role of this imaging method in this setting.


PET Positron emission tomography Choline Hyperparathyroidism Parathyroid 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no financial or non-financial competing interests.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Clinic of Nuclear Medicine and PET/CT Center, Ente Ospedaliero CantonaleOncology Institute of Southern SwitzerlandBellinzonaSwitzerland
  2. 2.Health Technology Assessment UnitEnte Ospedaliero CantonaleBellinzonaSwitzerland
  3. 3.Clinical Trial UnitEnte Ospedaliero CantonaleBellinzonaSwitzerland
  4. 4.Department of Nuclear Medicine and Molecular ImagingLausanne University HospitalLausanneSwitzerland
  5. 5.Department of Biophysics and Nuclear MedicineHôpital de Hautepierre-Hôpitaux Universitaires de StrasbourgStrasbourgFrance
  6. 6.Faculty of Medicine, ICubeUniversity of Strasbourg/CNRS (UMR 7357) and FMTSStrasbourgFrance
  7. 7.Department of Radiology and Nuclear MedicineLucerne Cantonal HospitalLucerneSwitzerland
  8. 8.Department of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland

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