Abstract
Objective
To compare detectability of hyperfunctioning parathyroid tissue (HPT) by digital and analog 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT.
Materials and methods
Thirty-three patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT were prospectively included. All patients accepted to be scanned by digital and analog PET/CT in the same imaging session after a single injection of 18F-fluorocholine. Three nuclear medicine physicians evaluated the digital and analog PET/CT datasets to assess the detection rate of HPT. Maximum standard uptake values (SUVmax) of HPT and locoregional lymph nodes were measured in both systems.
Results
HPT was detected in 30/33 patients by the digital system, whereas it was detected in 22/33 patients by the analog system (p < 0.01). Moreover, in 21 of these 33 patients, both systems detected one focal 18F-fluorocholine uptake, and in one patient the digital system detected two foci. Histopathology demonstrated HPT in 32 patients and it was inconclusive in one patient. The digital PET/CT detected HPT in 29 of the 32 patients, and the analog system in 22 of the 32 (p < 0.01). All HPT suspected lesions resected and detected only by the digital system (n = 8) were < 10 mm (7.5 ± 1.3 mm), while those detected by both systems (n = 22) were > 10 mm (13 ± 3.8 mm). SUVmax of HPT lesions was significantly higher than SUVmax of locoregional lymph node independently of the PET/CT system used (4.5 ± 1.9 vs. 2.9 ± 1.3, p < 0.0001).
Conclusions
Digital PET/CT offers superior performance over analog system in patients with suspected HPT and previous negative/inconclusive imaging examinations, particularly in sub-centimeter lesions. SUVmax can help in the differentiation between HTP and locoregional lymph nodes.
Similar content being viewed by others
Change history
16 March 2020
The correct administered activity of 18F-FCH is 0.1���0.14��mCi/Kg, which is equivalent to 3.7���5.2��MBq/kg.
References
Cordellat IM. Hyperparathyroidism: primary or secondary disease? Rheumatol Clin. 2012;8:287–91.
Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg. 2016;151:959–68.
Beheshti M, Hehenwarter L, Paymani Z, et al. 18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging. 2018;45:1762–71.
Treglia G, Piccardo A, Imperiale A, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2019;46:751–65.
Huber GF, Hüllner M, Schmid C, et al. Benefit of 18F-fluorocholine PET imaging in parathyroid surgery. Eur Radiol. 2018;28:2700–7.
Thanseer N, Bhadada SK, Sood A, et al. Comparative effectiveness of ultrasonography, 99mTc-sestamibi, and 18F-fluorocholine PET/CT in detecting parathyroid adenomas in patients with primary hyperparathyroidism. Clin Nucl Med. 2017;42:e491–7.
Bossert I, Chytiris S, Hodolic M, et al. PETC/CT with 18F-choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism. J Endocrinol Investig. 2019;42:419–26.
Nguyen NC, Vercher-Conejero JL, Sattar A, et al. Image quality and diagnostic performance of a digital PET prototype in patients with oncologic diseases: initial experience and comparison with analog PET. J Nucl Med. 2015;56:1378–85.
Frach T, Prescher G, Degenhardt C, et al. The digital silicon photomultiplier: principle of operation and intrinsic detector performance. IEEE Nucl Sci Symp Conf Rec. 2009:1959–65.
Degenhardt C, Prescher G, Frach T, et al. The digital silicon photomultiplier: a novel sensor for the detection of scintillation light. IEEE Nucl Sci Symp Conf Rec. 2009:2383–6.
Degenhardt C, Rodrigues P, Trindade A, et al. Performance evaluation of a prototype positron emission tomography scanner using digital photon counters (DPC). IEEE Nucl Sci Symp Conf Rec. 2012:2820–4.
López-Mora DA, Flotats A, Fuentes-Ocampo F, et al. Comparison of image quality and lesion detection between digital and analog PET/CT. Eur J Nucl Med Mol Imaging. 2019;46:1383–90.
Rausch I, Ruiz A, Valverde-Pascual I, et al. Performance evaluation of the Vereos PET/CT system according to the NEMA NU2–2012 standard. J Nucl Med. 2019;60:561–7.
Surti S, Kuhn A, Werner ME, et al. Performance of Philips Gemini TF PET/CT scanner with special consideration for its time-of-flight imaging capabilities. J Nucl Med. 2007;48:471–80.
Rausch I, Cal-González J, Dapra D, et al. Performance evaluation of the biograph mCT flow PET/CT system according to the NEMA NU2-2012 standard. EJNMMI Phys. 2015;2:26.
López-Mora DA, Estorch M, Fuentes-Ocampo F, et al. Digital PET/CT vs. analogue PET/CT in a parathyroid gland study with 18F-fluorocholine. Rev Esp Med Nucl Imagen Mol. 2019;38:121–2.
Broos WAM, Wondergem M, Knol RJJ, et al. Parathyroid imaging with 18F-fluorocholine PET/CT as a first-line imaging modality in primary hyperparathyroidism: a retrospective cohort study. EJNMMI Res. 2019;9:72.
Grimaldi S, Young J, Kamenicky P, et al. Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of (18)F-fluorocholine PET/CT. Eur J Nucl Med Mol Imaging. 2018;45:1772–80.
Amadou C, Bera G, Ezziane M, et al. 18F-Fluorocholine PET/CT and parathyroid 4D computed tomography for primary hyperparathyroidism: the challenge of reoperative patients. World J Surg. 2019;43:1232–42.
Khafif A, Masalha M, Landsberg R, et al. The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas. Eur Arch Otorhinolaryngol. 2019;276:1509–16.
Prabhu M, Kumari G, Damle NA, et al. Assessment of the role of early dynamic PET/CT with 18F-fluorocholine in detection of parathyroid lesions in patients with primary hyperparathyroidism. Nucl Med Commun. 2018;39:1190–6.
Fuentes-Ocampo F, López-Mora DA, Flotats A, et al. Digital vs. analog PET/CT: intra-subject comparison of the SUVmax in target lesions and reference regions. Eur J Nucl Med Mol Imaging. 2019;46:1745–50.
Funding
This study was funded in part by unrestricted grant from Philips Healthcare.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Diego Alfonso López-Mora declares that he has no conflict of interest. Marina Sizova declares that she has no conflict of interest. Montserrat Estorch declares that she has no conflict of interest. Albert Flotats declares that he has no conflict of interest. Valle Camacho declares that she has no conflict of interest. Alejandro Fernández declares that he has no conflict of interest. Safae Abouzian declares that she has no conflict of interest. Francisco Fuentes-Ocampo declares that he has no conflict of interest. José Ignacio Pérez Garcia declares that he has no conflict of interest. Anna Isabel Chico Ballesteros declares that she has no conflict of interest. Joan Duch declares that he has no conflict of interest. Anna Domènech declares that she has no conflict of interest. Antonio Moral Duarte declares that he has no conflict of interest. Ignasi Carrio has received research grants from Philips Healthcare. Ignasi Carrio has received a speaker honorarium from Philips Healthcare.
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.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Endocrinology
Electronic supplementary material
Supplementary Table
Biochemical and clinical characteristics of each patients with primary hyperparathyroidism and negative or inconclusive 99mTc-MIBI parathyroid scintigraphy-SPECT/CT. (JPG 256 kb)
Rights and permissions
About this article
Cite this article
López-Mora, D.A., Sizova, M., Estorch, M. et al. Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas. Eur J Nucl Med Mol Imaging 47, 572–578 (2020). https://doi.org/10.1007/s00259-020-04680-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-020-04680-7