title: Accurate preoperative localization of parathyroid adenomas with C-11 methionine PET/CT.
abstract: BACKGROUND
  Focused unilateral or minimally invasive parathyroidectomy for primary hyperparathyroidism (pHPT) depends on the successful preoperative localization of parathyroid adenomas. The aim of this prospective study was to determine the accuracy of C-11 methionine positron emission tomography/computed tomography (Met-PET/CT), a novel localization procedure for hyperfunctional parathyroid tissue.
  
  
  METHODS
  Preoperative Met-PET/CT scans of the neck and mediastinum of 102 patients undergoing parathyroidectomy for pHPT were preoperatively evaluated by a radiologist and a nuclear medicine physician and prospectively documented. The results of Met-PET/CT were compared with intraoperative and histopathological findings.
  
  
  RESULTS
  pHPT was caused by a single-gland adenoma in 97 patients, whereas 5 patients had multiglandular disease. Met-PET/CT correctly located a single-gland adenoma in 83 of 97 (86%) patients with pHPT (sensitivity 91%). The positive predictive value of Met-PET/CT in localizing a single-gland adenoma was 93%. Of the 5 patients with multiglandular disease, Met-PET/CT identified 2 hyperfunctioning parathyroid glands in 1 patient, 1 gland in 3 individuals, and was negative in the fifth patient (sensitivity 80%). A highly significant correlation was observed between true-positive findings and the size (mean = 1.81 ± 0.84 cm) and weight (mean = 1.50 ± 2.56 g) of parathyroid adenoma, whereas patients with false-negative findings had significantly smaller (mean = 1.09 ± 0.41 cm) and lighter (mean = 0.37 ± 0.29 g) glands (P < 0.001 and P = 0.001, respectively).
  
  
  CONCLUSIONS
  This study demonstrates the high accuracy of Met-PET/CT in the preoperative localization of parathyroid adenomas in a large series of patients with pHPT.
authors.affiliation: Department of Surgery, University Medical Center, Ulm, Germany. theresia.weber@uniklinik-ulm.de
authors.forename: Theresia
authors.initials: T
authors.lastname: Weber
authors.forename: Clemens
authors.initials: C
authors.lastname: Maier-Funk
authors.forename: Dagmar
authors.initials: D
authors.lastname: Ohlhauser
authors.forename: Andreas
authors.initials: A
authors.lastname: Hillenbrand
authors.forename: Gregor
authors.initials: G
authors.lastname: Cammerer
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Barth
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: Bernhard O
authors.initials: BO
authors.lastname: Boehm
authors.forename: Sven N
authors.initials: SN
authors.lastname: Reske
authors.forename: Markus
authors.initials: M
authors.lastname: Luster
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D005260:Female; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives; D008297:Male; D008715:Methionine; D008875:Middle Aged; D064847:Multimodal Imaging; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007472:Iohexol; C086242:carbon-11 methionine; C038192:iopromide; D008715:Methionine