title: A Pilot Comparison of 18F-fluorocholine PET/CT, Ultrasonography and 123I/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies.
abstract: We compared (18)F-fluorocholine hybrid positron emission tomography/X-ray computed tomography (FCH-PET/CT) with ultrasonography (US) and scintigraphy in patients with hyperparathyroidism and discordant, or equivocal results of US and (123)I/(99m)Tc-sesta-methoxyisobutylisonitrile (sestaMIBI) dual-phase parathyroid scintigraphy. FCH-PET/CT was performed in 17 patients with primary (n = 11) lithium induced (n = 1) or secondary hyperparathyroidism (1 dialyzed, 4 renal-transplanted).The reference standard was based on results of surgical exploration and histopathological examination. The results of imaging modalities were evaluated, on site and by masked reading, on per-patient and per-lesion bases.In a first approach, equivocal images/foci were considered as negative. On a per-patient level, the sensitivity was for US 38%, for scintigraphy 69% by open and 94% by masked reading, and for FCH-PET/CT 88% by open and 94% by masked reading. On a per-lesion level, sensitivity was for US 42%, for scintigraphy 58% by open and 83% by masked reading, and for FCH-PET/CT 88% by open and 96% by masked reading. One ectopic adenoma was missed by the 3 imaging modalities. Considering equivocal images/foci as positive increased the accuracy of the open reading of scintigraphy or of FCH-PET/CT, but not of US. FCH-PET/CT was significantly superior to US in all approaches, whereas it was more sensitive than scintigraphy only for open reading considering equivocal images/foci as negative (P = 0.04). FCH uptake was more intense in adenomas than in hyperplastic parathyroid glands. Thyroid lesions were suspected in 9 patients. They may induce false-positive results as in one case of oncocytic thyroid adenoma, or false-negative results as in one case of intrathyroidal parathyroid adenoma. Thyroid cancer (4 cases) can be visualized with FCH as with (99m)Tc-sestaMIBI, but the intensity of uptake was moderate, similar to that of parathyroid hyperplasia.This pilot study confirmed that FCH-PET/CT is an adequate imaging tool in patients with primary or secondary hyperparathyroidism, since both adenomas and hyperplastic parathyroid glands can be detected. The sensitivity of FCH-PET/CT was better than that of US and was not inferior to that of dual-phase dual-isotope (123)I/(99m)Tc-scintigraphy. Further studies should evaluate whether FCH could replace (99m)Tc-sestaMIBI as the functional agent for parathyroid imaging, but US would still be useful to identify thyroid lesions.
authors.affiliation: From the Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France (LM, SB, JO, VH, KK, FM, J-NT); Department of Nuclear Medicine, Comenius University & St. Elisabeth Oncology Institute, Bratislava, Slovakia (SB); Department of Otolaryngology Head and Neck Surgery, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (AB, SP); Faculté de Médecine Pierre et Marie Curie (JO, FM, SP, J-NT); Department of Pathology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris (ML); and Department of Radiology, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Paris, France (MT).
authors.forename: Laure
authors.initials: L
authors.lastname: Michaud
authors.forename: Sona
authors.initials: S
authors.lastname: Balogova
authors.forename: Alice
authors.initials: A
authors.lastname: Burgess
authors.forename: Jessica
authors.initials: J
authors.lastname: Ohnona
authors.forename: Virginie
authors.initials: V
authors.lastname: Huchet
authors.forename: Khaldoun
authors.initials: K
authors.lastname: Kerrou
authors.forename: Marine
authors.initials: M
authors.lastname: Lefèvre
authors.forename: Marc
authors.initials: M
authors.lastname: Tassart
authors.forename: Françoise
authors.initials: F
authors.lastname: Montravers
authors.forename: Sophie
authors.initials: S
authors.lastname: Périé
authors.forename: Jean-Noël
authors.initials: JN
authors.lastname: Talbot
mesh_terms: D002794:Choline / Q000031:analogs & derivatives; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery*; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D008297:Male; D010280:Parathyroid Glands / Q000166:cytology*; D010865:Pilot Projects; D049268:Positron-Emission Tomography / Q000379:methods; D057234:Preoperative Period; D011877:Radionuclide Imaging / Q000379:methods / Q000592:standards; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods / Q000592:standards
chemical_list: D019275:Radiopharmaceuticals; C514960:fluorocholine; D017256:Technetium Tc 99m Sestamibi; D002794:Choline