title: C-11 methionine positron emission tomography/computed tomography localizes parathyroid adenomas in primary hyperparathyroidism.
abstract: In patients with primary hyperparathyroidism (pHPT), positive preoperative localization studies enable to perform a minimally invasive approach for parathyroid surgery. However, current imaging techniques are not always successful. We therefore conducted a study to determine the sensitivity of C-11 methionine positron emission tomography/computed tomography (Met-PET/CT) in localizing parathyroid adenomas in pHPT. Met-PET/CT scans of the neck and mediastinum of 33 patients undergoing parathyroidectomy for primary HPT were compared with intraoperative and histological findings. Primary HPT was caused by a single gland adenoma in 30 patients, while another 3 patients had multiglandular disease. Met-PET/CT scan correctly located a single gland adenoma in 25 out of 30 (83%) patients with pHPT, among them 2 patients with persistent disease, 7 patients with prior neck surgery, and 8 patients with concomitant thyroid nodules. In 3 patients with multiglandular disease, Met-PET/CT showed only one enlarged parathyroid gland in two individuals and was negative in the third patient. Statistical analysis found a significant correlation between true-positive results and the weight (2.42+/-4.05 g) and diameter (2.0+/-1.18 cm) of parathyroid adenomas while the subgroup with false negative findings had significantly smaller (0.98+/-0.54 cm) and lighter (0.5+/-0.38 g) glands. Sensitivity was 83% for single gland adenomas and 67% for multiglandular disease. Met-PET/CT correctly localized 83% of single gland parathyroid adenomas in patients with pHPT. However, preoperative localization of multiglandular disease due to double adenomas or parathyroid hyperplasia remained difficult.
authors.affiliation: Department of Surgery, University Medical Center, Ulm, Germany. theresia.weber@uniklinik-ulm.de
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.forename: G
authors.initials: G
authors.lastname: Cammerer
authors.forename: C
authors.initials: C
authors.lastname: Schick
authors.forename: C
authors.initials: C
authors.lastname: Solbach
authors.forename: A
authors.initials: A
authors.lastname: Hillenbrand
authors.forename: T F
authors.initials: TF
authors.lastname: Barth
authors.forename: D
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: R
authors.initials: R
authors.lastname: Blagieva
authors.forename: B O
authors.initials: BO
authors.lastname: Böhm
authors.forename: S N
authors.initials: SN
authors.lastname: Reske
authors.forename: M
authors.initials: M
authors.lastname: Luster
mesh_terms: D000236:Adenoma / Q000150:complications / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000000981:diagnostic imaging*; D007430:Intraoperative Care; D008297:Male; D008715:Methionine; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging / Q000601:surgery; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: C086242:carbon-11 methionine; D008715:Methionine