18F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study

Purpose

Primary hyperparathyroidism is a common endocrine disorder which is diagnosed biochemically and for which therapy is surgical. A prerequisite for minimally invasive surgery, which minimizes morbidity and cost, is accurate localization of the involved gland(s). The aim of this study was to evaluate the usefulness of ¹⁸F-fluorocholine PET/CT for preoperative localization of hyperfunctioning parathyroid tissue.

Methods

¹⁸F-Fluorocholine PET/CT and conventional parathyroid scintigraphic imaging consisting of ^99mTc-sestaMIBI SPECT/CT, ^99mTc-sestaMIBI dual-phase imaging and ^99mTc-sestaMIBI/pertechnetate subtraction imaging were performed in 24 patients. The diagnostic performance of the imaging methods was compared against histology as the gold standard and postoperative serum Ca²⁺ and iPTH values.

Results

The sensitivity and specificity of ¹⁸F-fluorocholine PET/CT were 92 % and 100 %, respectively, in contrast to 49 % and 100 %, 46 % and 100 %, and 44 % and 100 % for ^99mTc-sestaMIBI SPECT/CT, ^99mTc-sestaMIBI/pertechnetate subtraction imaging and ^99mTc-sestaMIBI dual-phase imaging, respectively. Combined conventional scintigraphic imaging had a sensitivity and specificity of 64 % and 100 %, respectively. The performance of ¹⁸F-fluorocholine PET/CT was superior particularly in patients with multiple lesions or hyperplasia.

Conclusion

¹⁸F-Fluorocholine PET/CT appears to be a promising, effective imaging method for localization of hyperfunctioning parathyroid tissue.