Abstract
BackgroundIdentifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a next in-line scan after primary negative or discordant first-line imaging.MethodsThis was a retrospective single-center cohort study. All patients with pHPT that were scanned utilizing 11C-choline PET/CT, after prior negative or discordant imaging, between 2015 and 2019 and who subsequently underwent parathyroid surgery were included. The results of the 11C-choline PET/CT were evaluated lesion-based, with surgical exploration and histopathological examination as the gold standard.ResultsIn total, 36 patients were included of which three patients were known to have Multiple Endocrine Neoplasia (MEN) syndrome. In these 36 patients, 40 lesions were identified on 11C-choline PET/CT and 37 parathyroid lesions were surgically removed. In 34/36 (94%) patients a focused parathyroidectomy was performed, in one patient a cervical exploration due to an ectopically identified adenoma, and in one patient a bilateral exploration was performed because of a double adenoma. Overall, per-lesion sensitivity of 11C-choline PET/CT was 97%, the positive predictive value was 95% and the accuracy was 94% for all parathyroid lesions.ConclusionsIn patients with pHPT and prior negative or discordant first-line imaging results, pathological parathyroid glands can be localized by 11C-choline PET/CT with high sensitivity and accuracy.
Highlights
Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism is crucial as it can guide surgical treatment
Since a solitary adenoma is the predominant cause, parathyroid surgery is preferably performed through a minimally invasive parathyroidectomy (MIP) in which only the suspected adenoma is resected in a focused manner
For the remaining 10–20% of patients, a bilateral neck exploration (BNE) could be avoided if other innovative functional imaging techniques using positron emission tomography (PET)/Computed tomorgraphy (CT), with radiotracers such as 11C-methionine and 11C-choline/18F-fluorocholine, would be able to localize the adenoma [6,7,8,9,10]
Summary
Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a in-line scan after primary negative or discordant first-line imaging. Since a solitary adenoma is the predominant cause, parathyroid surgery is preferably performed through a minimally invasive parathyroidectomy (MIP) in which only the suspected adenoma is resected in a focused manner. For the remaining 10–20% of patients, a BNE could be avoided if other innovative functional imaging techniques using positron emission tomography (PET)/CT, with radiotracers such as 11C-methionine and 11C-choline/18F-fluorocholine, would be able to localize the adenoma [6,7,8,9,10]
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