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01-02-2022 | Endocrine Surgery | Original Article

¹⁸F-Fluorocholine-PET combined with contrast-enhanced CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism

Authors: Jörn-Markus Gass, Corinna Wicke, Caroline Mona, Klaus Strobel, Werner Müller, Jürg Metzger, Isabelle Suter-Widmer, Christoph Henzen, Stefan Fischli

Published in: Endocrine | Issue 2/2022

Abstract

Purpose

Hyperparathyroidism (HPT) is a common disorder. A cure can only be achieved by removing all diseased glands. It is critical to localize the hyperfunctioning glands exactly to prevent extensive surgical exploration. The number of false negative/inconclusive results in standard imaging techniques is high. We aimed to evaluate the diagnostic accuracy of ¹⁸F-Fluorocholine-PET in combination with contrast-enhanced CT (FCH-PET/CT) and its sensitivity in patients with primary, secondary/tertiary, and familial HPT with negative and/or discordant findings in ultrasound and/or ^99mTc-sestamibi scintigraphy/SPECT/CT.

Methods

A total of 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. In this retrospective, single institution study, 69 patients, who have undergone surgery and histopathologic workup, were analyzed. Of the 69 patients included, 60 patients suffered from primary HPT, four from secondary or tertiary HPT, and five from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated.

Results

Sensitivity/positive predictive value (PPV) per lesion was 87.5/98.3% for primary HPT, 75/100% for secondary/tertiary HPT and 25/66.7% for familial HPT. Sensitivity/PPV per patient was 91.5/98.2% for primary HPT, 100/100% for secondary/tertiary HPT and 50/100% for familial HPT. All patients showed normalized serum calcium levels in the postoperative period. The follow-up rate was 97%. Of the patients included in the study, 58 of 60 patients with primary HPT, and four of four patients with secondary/tertiary HPT showed normal calcium and parathyroid hormone (PTH) levels after six months and were cured. Of the patients with familial HPT, four of five patients were cured.

Conclusion

Diagnostic accuracy of ¹⁸F-Fluorocholine-PET/CT for patients with pHPT is excellent. ¹⁸F-Fluorocholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.

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Title: 18F-Fluorocholine-PET combined with contrast-enhanced CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism
Authors: Jörn-Markus Gass
Corinna Wicke
Caroline Mona
Klaus Strobel
Werner Müller
Jürg Metzger
Isabelle Suter-Widmer
Christoph Henzen
Stefan Fischli
Publication date: 01-02-2022
Publisher: Springer US
Keywords: Endocrine Surgery
Hyperparathyroidism
Endocrine Surgery
Parathyroidectomy
Parathyroidectomy
Scintigraphy
Published in: Endocrine / Issue 2/2022
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-021-02877-w

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