Fluorine-18 fluorocholine PET-CT localizes hyperparathyroidism in patients with inconclusive conventional imaging: a multicenter study from the Netherlands.
BACKGROUND
Several reports have shown good performance of fluorine-18 fluorocholine (F-FCH) PET-computed tomography (CT) for parathyroid localization, although overall evidence remains scarce. We collected data from three institutions in the Netherlands and investigated the performance of F-FCH PET-CT as a second-line imaging modality.


METHODS
We performed a retrospective review of all patients at least 18 years who underwent F-FCH PET-CT for biochemically proven hyperparathyroidism (HPT) and inconclusive ultrasound and sestamibi scintigraphy. Acquisition of PET images was performed 30 min after the administration of 2 MBq/kg F-FCH, together with a low-dose CT.


RESULTS
PET-CT scans were performed in 33 (75%) women and 11 (25%) men with a mean age of 58.9 (range 31-80 years). Three patients had multiple endocrine neoplasia type 1, one patient had tertiary HPT because of Alport syndrome and the remaining patients had sporadic primary HPT. F-FCH PET-CT was positive in 34/44 (77.3%) cases. Of the 35 abnormal glands resected in 33 patients, F-FCH PET-CT could successfully localize 33/35 (94.3%), with only one false-positive result [positive predictive value (PPV)=97.1%]. Comparison of the 10 patients with negative PET-CT with the 34 patients with positive PET-CT showed no significant differences in age, sex, ratio of preoperative calcium, use of cinacalcet, history of neck surgery, and concomitant multinodular goiter.


CONCLUSIONS
Our study shows excellent performance of F-FCH PET-CT in patients with HPT and inconclusive conventional imaging. Because of its favorable characteristics with high performance, prospective studies should be initiated to determine whether this new technique may replace conventional sestamibi scintigraphy as a first-line imaging modality.
Departments of aSurgery bInternal Medicine cNuclear Medicine, University Medical Center Utrecht dDepartment of Surgery, Diakonessenhuis Hospital Utrecht, Utrecht eDepartment of Nuclear Medicine, Meander Medical Centre, Amersfoort, The Netherlands.
Wouter P
WP
Kluijfhout
Wessel M C M
WM
Vorselaars
Sandra A M
SA
van den Berk
Menno R
MR
Vriens
Inne H M
IH
Borel Rinkes
Gerlof D
GD
Valk
Thijs
T
van Dalen
John M H
JM
de Klerk
Bart
B
de Keizer
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002794:Choline / Q000031:analogs & derivatives*; D003951:Diagnostic Errors; D005260:Female; D005462:Fluorine Radioisotopes; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods* / Q000706:statistics & numerical data; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D017256:Technetium Tc 99m Sestamibi; D014463:Ultrasonography
D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; C514960:fluorocholine; D017256:Technetium Tc 99m Sestamibi; D002794:Choline