title: Localization of parathyroid adenoma by ¹¹C-choline PET/CT: preliminary results.
abstract: OBJECTIVE
  This prospective pilot study was aimed to evaluate ¹¹C-choline PET/CT (choline) as a tool for localization of parathyroid adenoma (PTA).
  
  
  METHODS
  Forty patients with biochemical hyperparathyroidism underwent choline and ⁹⁹mTc-MIBI imaging within a median interval of 56 days. Choline and MIBI images were analyzed and correlated with each other, with additional modalities such as ultrasound, CT, MRI, and with surgical findings, when available.
  
  
  RESULTS
  Thirty-seven of forty cases were choline-positive, and 3 were choline-negative. Choline uptake on PET was identified with corresponding nodules on CT of the PET/CT, yielding precise localization. Twenty of thirty-seven foci were located in typical sites in the neck, and 17 were ectopic. Clear visualization of PTA was achieved in 33 of 37, whereas findings in 4 cases were suspicious for PTA. MIBI was positive in 33 of 40 cases (22 clearly positive, 11 suspicious). In 29 of 40 cases, choline and MIBI were concordant, but choline findings were clearer in 9 of these 29 studies.At the time of writing, 27 patients had undergone surgery. In 24 cases, there was complete matching of choline with surgical findings of PTA. Overall in 23 cases, both choline and MIBI matched surgical findings of PTA. In 1 case, PTA was correctly localized on choline but not on MIBI, and in 2 cases, neither choline nor MIBI corresponded to the surgical findings.
  
  
  CONCLUSIONS
  These preliminary results indicate that the combined functional and anatomical modality of choline PET/CT is a promising tool for PTA localization, providing clearer images than MIBI, equal or better accuracy, and quicker and easier acquisition.
authors.affiliation: From the *Department of Nuclear Medicine, and †Cyclotron Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Marina
authors.initials: M
authors.lastname: Orevi
authors.forename: Nanette
authors.initials: N
authors.lastname: Freedman
authors.forename: Eyal
authors.initials: E
authors.lastname: Mishani
authors.forename: Moshe
authors.initials: M
authors.lastname: Bocher
authors.forename: Orit
authors.initials: O
authors.lastname: Jacobson
authors.forename: Yodphat
authors.initials: Y
authors.lastname: Krausz
mesh_terms: D000236:Adenoma / Q000097:blood / Q000000981:diagnostic imaging*; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D002250:Carbon Radioisotopes; D002794:Choline; D005260:Female; D006801:Humans; D006980:Hyperthyroidism / Q000097:blood / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010282:Parathyroid Neoplasms / Q000097:blood / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D002794:Choline; D002118:Calcium