title: Preoperative ¹¹C-methionine PET/CT enables focused parathyroidectomy in MIBI-SPECT negative parathyroid adenoma.
abstract: BACKGROUND
  Precise preoperative localization is essential for focussed parathyroidectomy. The imaging standard consists of cervical ultrasonography (cUS) and (99m)Tc-MIBI-SPECT (MIBI-SPECT). (11)C-methionine positron emission tomography/computed tomography (Met-PET/CT) is a promising method for localizing parathyroid adenomas. The objective of our study was to elucidate whether additional Met-PET/CT increases the rate of focussed parathyroidectomy.
  
  
  METHODS
  Fourteen patients with primary hyperparathyroidism (HPT) and three patients with tertiary HPT underwent cUS and MIBI-SPECT. Met-PET/CT was carried out in patients with negative MIBI results. Subsequent surgical strategy was adapted according to imaging results.
  
  
  RESULTS
  cUS localized a single parathyroid adenoma in 10/17 patients (59 %), while MIBI-SPECT/CT identified 11/17 single adenomas (65 %). In the remaining six patients, Met-PET/CT identified five single adenomas. This step-up approach correctly identified single adenomas in 16/17 patients (94 %).
  
  
  CONCLUSIONS
  Met-PET/CT raises the rate of correctly localized single parathyroid adenomas in patients with negative cUS and MIBI-SPECT/CT and increases the number of focussed surgical approaches.
authors: Department of General Surgery and Visceral Surgery, University Hospital of Muenster, Waldeyerstrasse 1, 48149, Muenster, Germany, Christina.Lenschow@ukmuenster.de.
authors: Christina
authors: C
authors: Lenschow
authors: Peter
authors: P
authors: Gassmann
authors: Christian
authors: C
authors: Wenning
authors: Norbert
authors: N
authors: Senninger
authors: Mario
authors: M
authors: Colombo-Benkmann
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery*; D000368:Aged; D002250:Carbon Radioisotopes; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging / Q000209:etiology; D008297:Male; D008715:Methionine; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D016105:Parathyroidectomy; D057234:Preoperative Period; D012680:Sensitivity and Specificity; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014463:Ultrasonography
chemical_list: D002250:Carbon Radioisotopes; D017256:Technetium Tc 99m Sestamibi; D008715:Methionine