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European Journal of Nuclear Medicine and Molecular Imaging

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01-04-2006 | Original Article

¹¹C-methionine PET/CT in ^99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis

Authors: Domenico Rubello, Stefano Fanti, Cristina Nanni, Mohsen Farsad, Paolo Castellucci, Stefano Boschi, Roberto Franchi, Giuliano Mariani, Lorraine M. Fig, Milton D. Gross

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 4/2006

Abstract

Purpose

Scintigraphic localisation of parathyroid glands is often unsuccessful in patients with renal failure on chronic haemodialysis who have secondary hyperparathyroidism (HPT). The purpose of this study was to investigate the use of ¹¹C-methionine PET/CT to detect hyperfunctioning parathyroid glands in patients with renal failure on chronic haemodialysis who had ^99mTc-sestamibi-negative HPT.

Methods

¹¹C-methionine PET/CT was performed in 18 patients (11 women and 7 men, aged 42–79 years; mean age 57.8 years) on haemodialysis for renal failure (2–14 years’ duration), with normo-, hypo- or hypercalcaemia and HPT not localised by either dual-tracer ^99mTc-pertechnetate/^99mTc-sestamibi subtraction scans or dual-phase ^99mTc-sestamibi scans.

Results

In three of ten patients with normo- or hypocalcaemic HPT there was increased ¹¹C-methionine accumulation in one gland. Seven of eight patients with hypercalcaemic HPT showed increased uptake: in five of these patients increased ¹¹C-methionine accumulation was present in one gland, while in two it was demonstrated in two glands. All patients also had high-resolution ultrasound of the neck and were treated with subtotal parathyroidectomy, leaving a remnant of the smallest of the four glands. Regardless of their size, all glands with abnormal ¹¹C-methionine parathyroid uptake were removed, and all demonstrated parathyroid hyperplasia. All patients developed post-parathyroidectomy hypoparathyroidism and one patient with normocalcaemic HPT relapsed 8 months after surgery.

Conclusion

These data suggest that ¹¹C-methionine PET/CT may be used to identify hyperfunctioning parathyroid glands in non-primary HPT, and especially hypercalcaemic HPT, when conventional ^99mTc-sestamibi imaging is non-localising.

Potchen EJ, Wilson RE, Dealy JB Jr. External parathyroid scanning with Se75 selenomethionine. Ann Surg 1965;162:492–504.PubMedCrossRef

Sack H, Petry R, Duwell HJ. Darstellung eines Nebenschilddrusenadenoms mit Selen-methionin und der Szintillationskamera. Dtsch Med Wochenschr 1965;90:2353–4.PubMed

Grebe SF. Szintigraphische Darstellung eines Parathyreoideaadenoms mit⁷⁵Se-methionin. Med Klin 1967;62:672–4.PubMed

Piret L, Beckers C, DeVisscher M. Interet de la gammagraphy a la⁷⁵Se-selenomethionine dans la mise en evidence pre-operatoire de tumeurs parathyroidiennes. Revue Medicale de Liege (Suppl) 1968;1:225.

Conte N, Ziliotto D, Scandellari C. Localizzazione scintigrafica delle neoplasie paratiroidee con seleniometionina-Se-75. Acta Isot (Padova) 1965;5:337–45.

Askhar FS, Naya JL, Smith EM. Parathyroid scanning with⁷⁵Se-selenomethionine and glucagon stimulation. J Nucl Med 1971;12:751–3.

Winzelberg GG, Hydovitz JD. Radionuclide imaging of parathyroid tumors: historical perspectives and newer techniques. Semin Nucl Med 1985;15:161–70.PubMedCrossRef

O’Doherty MJ, Kettle AG. Parathyroid imaging: preoperative localization. Nucl Med Commun 2003;24:125–31.PubMedCrossRef

Sekiyama K, Akaakura K, Mikami K, Mizoguchi K-I, Tobe T, Nakano K, et al. Usefulness of diagnostic imaging in primary hyperparathyroidism. Int J Urol 2003;10:7–11.PubMedCrossRef

10.

Clark PB, Case D, Watson NE, Perrier ND, Morton K. Enhanced scintigraphic protocol required for optimal preoperative localization before targeted minimally invasive parathyroidectomy. Clin Nucl Med 2003;28:955–60.PubMedCrossRef

11.

Cook GJ, Wong JC, Smellie WJ, Young AE, Maisey MN, Fogelman I. [¹¹C]methionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism after surgery. Eur J Endocrinol 1998;139:195–7.PubMedCrossRef

12.

Sundin A, Johansson C, Hellman P, Bergstrom M, Ahlstrom H, Jacobson GB, et al. PET and parathyroid L-[carbon-11] methionine accumulation in hyperparathyroidism. J Nucl Med 1996;37:1766–70.PubMed

13.

Hellman P, Ahlstrom H, Bergstrom M, Sundin A, Langstrom B, Westerberg G, et al. Positron emission tomography with ¹¹C-methionine in hyperparathyroidism. Surgery 1994;116:974–81.PubMed

14.

Otto D, Boerner AR, Hoffman M, Brunkhorst T, Meyer GJ, Petrich T, et al. Pre-operative localization of hyperfunctional parathyroid tissue with¹¹C-methionine PET. Eur J Nucl Med Mol Imaging 2004;31:1405–12.PubMedCrossRef

15.

Rubello D, Pelizzo MR, Boni G, Schiavo R, Vagelli L, Villa G, et al. Radioguided surgery of primary hyperparathyroidism using the low-dose^99mTc-sestamibi protocol: multiinstitutional experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS). J Nucl Med 2005;46:220–6.PubMed

16.

Pascali C, Bogni A, Iwata R, Decise D, Crippa F, Bombardieri E. High efficiency preparation of L-[S-methyl-¹¹C]-methionine by on-column ¹¹C methylation on C18 Sep-Pak. J Labelled Cpd Radiopharm 1999;42:715–24.CrossRef

17.

Rubello D, Pelizzo MR, Gross MD, Fig LM, Shapiro B, Mariani G. Controversies on minimally invasive procedures for radio-guided surgery of parathyroid tumours. Minerva Endocrinol 2004;29:189–93.PubMed

18.

Van der Wall H, Carmalt H, Fogelman I. ^99mTc-sestamibi and minimally invasive radioguided surgery for primary hyperparathyroidism. J Nucl Med 2005;46:198–99.PubMed

19.

Gotthardt M, Lohmann B, Behr TM, Bauhofer A, Franzius C, Schipper ML, et al. Clinical value of parathyroid scintigraphy with technetium-99m methoxyisobutylisonitrile: discrepancies in clinical data and a systematic metaanalysis of the literature. World J Surg 2004;28:100–7.PubMedCrossRef

20.

Ryan JA, Faye TL. Maximizing outcomes while minimizing exploration in hyperparathyroidism using localization tests. Arch Surg 2004;139:838–43PubMedCrossRef

21.

Biertho L, Kim C, Wu H-S, Unger P, Inabnet WB. Relationship between sestamibi uptake, parathyroid hormone assay, and nuclear morphology in primary hyperparathyroidism. J Am Coll Surg 2004;199:229–33.PubMedCrossRef

22.

Kakuta T, Suzuki Y, Tadaki F, Tanaka R, Sakai H, Kurokawa K, et al. Long-term prognosis of parathyroid function for chronic dialysis patients after minimally invasive radioguided parathyroidectomy (MIRP). Nephrol Dial Transplant 2003;18 (Suppl 3):iii71–75.PubMed

23.

Fuster D, Ybarra J, Torregrosa JV, Setoain X, Martín F, Otrega ML, et al. Double-phase parathyroid ^99mTc-sestamibi scintigraphy in chronic hemodialysis patients: correlation with biochemical markers of parathyroid function. Nucl Med Commun 2003;24:85–90.PubMedCrossRef

24.

Pons F, Torregrosa JV, Vidal-Sicart S. Preoperative parathyroid gland localization with technetium-99m sestamibi in secondary hyperparathyroidism. Eur J Nucl Med 1997;24:1494–8.PubMedCrossRef

25.

Newmann DR, Esselstyn Jr. CB, MacIntyre WJ, Chen EQ, Go RT, Licata AA. Regional body FDG-PET in post-operative recurrent hyperparathyroidism. J Comput Assist Tomogr 1997;21:25–8.CrossRef

26.

Pacak K, Eisenhofer G, Goldstein DS. Functional imaging of endocrine tumors: role of positron emission tomography. Endocr Rev 2004;25:568–80.PubMedCrossRef

27.

Beggs AD, Hain SF. Localization of parathyroid adenomas using¹¹C-methionine position emission tomography. Nucl Med Commun 2005;26:133–6.PubMedCrossRef

28.

Sfakianakis GN, Irvin GL, Foss J, Foss J, Mallin W, Georgiou M, et al. Efficient parathyroidectomy guided by SPECT-MIBI and hormonal measurements. J Nucl Med 1996;37:798–804.PubMed

29.

Moka D, Voth E, Dietlein M, Larena-Avellaneda A, Schicha H. Technetium 99m-MIBI-SPECT: a high sensitive diagnostic tool for localization of parathyroid adenomas. Surgery 2000;128:29–35.PubMedCrossRef

Title: 11C-methionine PET/CT in 99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis
Authors: Domenico Rubello
Stefano Fanti
Cristina Nanni
Mohsen Farsad
Paolo Castellucci
Stefano Boschi
Roberto Franchi
Giuliano Mariani
Lorraine M. Fig
Milton D. Gross
Publication date: 01-04-2006
Publisher: Springer-Verlag
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 4/2006
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-005-0008-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

¹¹C-methionine PET/CT in ^99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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