title: Localization of parathyroid adenomas using11C-methionine pet after prior inconclusive imaging.
abstract: OBJECTIVE
  Minimally invasive parathyroidectomy (MIP) is the recommended treatment in primary hyperparathyroidism (pHPT) for which accurate preoperative localization is essential. The current imaging standard consists of cervical ultrasonography (cUS) and MIBI-SPECT/CT.11C-MET PET/CT has a higher resolution than MIBI-SPECT/CT. The aim of this study was to determine the diagnostic performance of11C-MET PET/CT after initial inconclusive or negative localization.
  
  
  METHODS
  We performed a retrospective single center cohort study of patients with pHPT undergoing parathyroid surgery after prior negative imaging and later localization by means of11C-MET PET/CT between 2006 and 2014. Preoperative localization by11C-MET PET/CT was compared with later surgical localization, intraoperative quick PTH (IOPTH), duration of surgery, histopathology, and follow-up data. Also, differences in duration of surgery between the groups with and without correct preoperative localization were analyzed.
  
  
  RESULTS
  In 18/28 included patients a positive11C-MET-PET/CT result corresponded to the surgical localized adenoma (64%). In 3/28 patients imaging was false positive and no adenoma was found. In 7/28 patients imaging was false negative at the side of the surgically identified adenoma. Sensitivity of11C-MET PET/CT was 72% (18/25). Duration of surgery of correctly localized patients was significantly shorter compared to falsely negative localized patients (p = 0.045).
  
  
  CONCLUSIONS
  In an intention to treat11C-MET-PET/CT correctly localized the parathyroid adenoma in 18/28 (64%) patients, after previous negative imaging. A preoperatively correct localized adenoma leads to a more focused surgical approach (MIP) potentially reducing duration of surgery and potentially healthcare costs.
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen, The Netherlands.
authors.forename: Milou E
authors.initials: ME
authors.lastname: Noltes
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen, The Netherlands.
authors.forename: Annemieke M
authors.initials: AM
authors.lastname: Coester
authors.affiliation: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Anouk N A
authors.initials: ANA
authors.lastname: van der Horst-Schrivers
authors.affiliation: Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Dorgelo
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen, The Netherlands.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Jansen
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Walter
authors.initials: W
authors.lastname: Noordzij
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen, The Netherlands.
authors.forename: Clara
authors.initials: C
authors.lastname: Lemstra
authors.affiliation: Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Adrienne H
authors.initials: AH
authors.lastname: Brouwers
authors.affiliation: Department of Surgery, University of Groningen, University Medical Center Groningen, P.O. Box 30001, Groningen, The Netherlands. s.kruijff@umcg.nl.
authors.forename: Schelto
authors.initials: S
authors.lastname: Kruijff
mesh_terms: D000236:Adenoma / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002250:Carbon Radioisotopes; D005260:Female; D006801:Humans; D008297:Male; D008715:Methionine; D008875:Middle Aged; D010282:Parathyroid Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D016105:Parathyroidectomy; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
chemical_list: D002250:Carbon Radioisotopes; C000615233:Carbon-11; D008715:Methionine
keywords: 11C-methionine positron emission tomography (11C-MET PET); Minimally invasive parathyroidectomy (MIP); Primary hyperparathyroidism (pHPT)