title: Use of PET tracers for parathyroid localization: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers.
  
  
  METHODS
  A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) post-surgical and pathological diagnosis as the gold standard. Performance was expressed in sensitivity and PPV.
  
  
  RESULTS
  Twenty-four papers were included subdivided by radiopharmaceutical: 14 studies investigated L-[11C]Methionine (11C-MET), one [11C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG), one 6-[18F] fluoro-L-DOPA (18F-DOPA), and three N-[(18F)Fluoromethyl]-2-hydroxy-N,N-dimethylethanaminium (18F-FCH). The 14 studies investigating MET included a total of 327 patients with 364 lesions. Sensitivity for the detection of a lesion in the correct quadrant had a pooled estimate of 69 % (95 % CI 60-78 %). Heterogeneity was overall high with I2of 51 % (p = 0.01) for all 14 studies. Pooled PPV ranged from 91 to 100 % with a pooled estimate of 98 % (95 % CI 96-100 %). Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance.
  
  
  CONCLUSIONS
  The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPV and may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA. wpkluijfhout@gmail.com.|Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands. wpkluijfhout@gmail.com.
authors.forename: Wouter P
authors.initials: WP
authors.lastname: Kluijfhout
authors.affiliation: Department of Surgery, University Health Network, Toronto, ON, Canada.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Pasternak
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Frederick Thurston
authors.initials: FT
authors.lastname: Drake
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Toni
authors.initials: T
authors.lastname: Beninato
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Gosnell
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Wen T
authors.initials: WT
authors.lastname: Shen
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Quan-Yang
authors.initials: QY
authors.lastname: Duh
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Isabel E
authors.initials: IE
authors.lastname: Allen
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Menno R
authors.initials: MR
authors.lastname: Vriens
authors.affiliation: Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: de Keizer
authors.affiliation: Department of Nuclear Medicine, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Miguel H
authors.initials: MH
authors.lastname: Pampaloni
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Insoo
authors.initials: I
authors.lastname: Suh
mesh_terms: D002250:Carbon Radioisotopes; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D008715:Methionine; D016105:Parathyroidectomy; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
chemical_list: D002250:Carbon Radioisotopes; D019275:Radiopharmaceuticals; D008715:Methionine
keywords: 11C-Methionine; 18F-Fluorocholine; Minimal invasive parathyroidectomy; PET/CT; Primary hyperparathyroidism