title: (18)F-Fluorocholine PET-CT enables minimal invasive parathyroidectomy in patients with negative sestamibi SPECT-CT and ultrasound: A case report.
abstract: BACKGROUND
  Primary hyperparathyroidism is a common endocrine disorder for which the primary treatment is surgery. For minimal invasive parathyroidectomy adequate pre-operative imaging is essential. Conventional imaging is often inconclusive. There are reports that (18)F-fluorocholine PET-CT might be a superior imaging modality, however evidence is still very scarce. This is the first report of a case with negative ultrasound and sestamibi SPECT-CT imaging that underwent successful minimal invasive surgery because of (18)F-fluorocholine PET-CT.
  
  
  METHODS
  A 57 year-old man presented to us with complaints of fatigue. Laboratory results showed a biochemical primary hyperparathyroidism and an additional DEXA-scan revealed osteopenia of the lumbar spine. Conventional imaging consisting of neck ultrasound and Tc-99m-sestamibi SPECT-CT was however unable to localize the pathological gland. Subsequent (18)F-fluorocholine PET-CT did clearly localize an adenoma dorsally of the left thyroid lobe which was removed at that exact location using minimal invasive parathyroidectomy. Histological examination confirmed the diagnosis adenoma and calcium levels remained normal at follow-up.
  
  
  CONCLUSIONS
  There is clinical need for a superior imaging modality to detect pathological parathyroid glands to enable minimal invasive surgery. (18)F-Fluorocholine is widely available.
  
  
  CONCLUSIONS
  (18)F-Fluorocholine PET-CT is a promising new imaging modality for localizing parathyroid adenomas and enabling minimal invasive parathyroidectomy when conventional imaging fails to do. Clinicians should consider its use as a second line modality for optimal patient care.
authors.affiliation: Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: Wpkluijfhout@gmail.com.
authors.forename: Wouter P
authors.initials: WP
authors.lastname: Kluijfhout
authors.affiliation: Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: M.R.Vriens@umcutrecht.nl.
authors.forename: Menno R
authors.initials: MR
authors.lastname: Vriens
authors.affiliation: Department of Endocrinology, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: G.D.Valk@umcutrecht.nl.
authors.forename: Gerlof D
authors.initials: GD
authors.lastname: Valk
authors.affiliation: Department of Internal Medicine; Central Military Hospital, Utrecht, The Netherlands. Electronic address: R.E.Barth@umcutrecht.nl.
authors.forename: Roos E
authors.initials: RE
authors.lastname: Barth
authors.affiliation: Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: I.H.M.BorelRinkes@umcutrecht.nl.
authors.forename: Inne H M
authors.initials: IH
authors.lastname: Borel Rinkes
authors.affiliation: Department of Nuclear Medicine; University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: B.deKeizer@umcutrecht.nl.
authors.forename: Bart
authors.initials: B
authors.lastname: de Keizer
keywords: (18)F-Fluorocholine PET–CT; Minimal invasive parathyroidectomy; Parathyroid adenoma; Primary hyperparathyroidism