Abstract
The aims of the present systematic review were to: (1) assess the role of 18F-fluorocholine (FCH) positron emission tomography (PET) with computed tomography (CT) and PET with magnetic resonance imaging (MRI) in patients with biochemically known hyperparathyroidism; (2) compare the diagnostic performance of FCH PET/CT or PET/MRI with conventional morphological and functional imaging. A literature search until December 2019 was performed in the PubMed, Scopus and Web of Science databases, using the terms “choline” AND “PET” AND “hyperparathyroidism”. The search was conducted with and without the addition of filters (e.g., language: English only; type of article: original article; subjects: humans only) and selecting only articles published in the last 5 years. Twenty-three articles and 1112 patients were considered. Different FCH PET/CT acquisition protocols were adopted across the studies, using dynamic, early or delayed scans. FCH PET/CT proved more accurate than ultrasonography (US) or 99mTc-sestamibi single-photon emission tomography (SPET). PET/MRI also seemed to be more accurate than MRI alone in detecting benign parathyroid lesions. FCH PET/CT is more accurate than conventional morphological and functional imaging modalities (US or SPET) for the detection of benign parathyroid lesions. It could, therefore, be a reliable tool in both primary and recurrent hyperparathyroidism.
Highlights
Primary hyperparathyroidism (PHPT) is a rather common endocrinological disorder, the third most common endocrine disease after diabetes mellitus and thyroid disorders
The systematic literature search generated 23 articles concerning a total of 1112 patients investigated with FCH positron emission tomography (PET)/computed tomography (CT) for the detection of benign parathyroid lesions
A careful analysis of the selected literature showed that a dynamic FCH PET/CT protocol was used in 4/23 studies
Summary
Primary hyperparathyroidism (PHPT) is a rather common endocrinological disorder, the third most common endocrine disease after diabetes mellitus and thyroid disorders It is characterized by one or more hyperfunctioning parathyroid glands [1], due to parathyroid adenoma (in > 80% of cases), PHPT may be associated with a higher risk of cardiovascular disease and mortality [5, 6]. A recent cost-effectiveness analysis on patients with non-localized PHPT showed that use of advanced imaging methods is more cost-effective than routine bilateral neck exploration [6]. Based on this evidence, it becomes essential to employ appropriate methods capable of revealing which parathyroid glands are causing PHPT. This is important to avoid unnecessary surgery and to identify ectopic parathyroid glands
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