Is C-11 Methionine PET/CT Able to Localise Sestamibi-Negative Parathyroid Adenomas?
Patients with primary hyperparathyroidism (pHPT) and a negative preoperative Tc-99 sestamibi (MIBI) scintigraphy are considered to have a higher risk of persistent disease. The aim of this study was to assess whether additional imaging with C-11 methionine positron emission tomography/computed tomography (Met-PET/CT) is able to localise sestamibi-negative hyperfunctioning parathyroid glands.



In 50 patients (38 females, 12 males, age 13-81 years) with pHPT and negative localisation procedures such as ultrasound and sestamibi, a Met-PET/CT was performed before parathyroid surgery. The results of Met-PET/CT were analysed prospectively and compared with intraoperative and histopathological findings. 22% of the patients underwent previous parathyroid and/or thyroid surgery.



Met-PET/CT correctly located a single-gland adenoma in 33 of 45 (73%) patients with pHPT. In 5 patients with multiglandular disease, Met-PET/CT detected at least one hyperfunctional parathyroid gland in 4 patients (80%). In 3 patients with double adenomas, 5 of 6 parathyroids were correctly located. Overall, 40 of 57 (70%) hyperfunctioning glands were identified with Met-PET/CT. Met-PET/CT was false-negative in 12 of 50 (24%) patients and false-positive in only one case (2%). Postoperatively, 48 of 50 patients (96%) were cured.



Additional pre-interventional imaging with Met-PET/CT was able to identify hyperfunctioning parathyroid glands in 74% of patients with pHPT and negative sestamibi scans, thus enabling successful parathyroid surgery.
Department of Endocrine Surgery, Katholisches Klinikum Mainz, An der Goldgrube 11, 55131, Mainz, Germany. t-weber@kkmainz.de.
Theresia
T
Weber
Department of Nuclear Medicine, University Medical Center Ulm, Ulm, Germany.
Martin
M
Gottstein
Department of Nuclear Medicine, University Medical Center Ulm, Ulm, Germany.
Sabrina
S
Schwenzer
Department of Nuclear Medicine, University Medical Center Ulm, Ulm, Germany.
Ambros
A
Beer
Department of Nuclear Medicine, University of Marburg, Marburg, Germany.
Markus
M
Luster
D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000209:etiology; D008297:Male; D008715:Methionine; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging*; D016105:Parathyroidectomy; D000072078:Positron Emission Tomography Computed Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D055815:Young Adult
D019275:Radiopharmaceuticals; C086242:carbon-11 methionine; D017256:Technetium Tc 99m Sestamibi; D008715:Methionine