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European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 10/2018

01-09-2018 | Original Article

Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-Fluorocholine PET/CT

Authors: Serena Grimaldi, Jacques Young, Peter Kamenicky, Dana Hartl, Marie Terroir, Sophie Leboulleux, Amandine Berdelou, Julien Hadoux, Segolene Hescot, Hervé Remy, Eric Baudin, Martin Schlumberger, Désirée Deandreis

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2018

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Abstract

Purpose

To evaluate the added value of 18F-Fluorocholine (18F-FCH) PET/CT in presurgical imaging of patients with primary hyperparathyroidism (HPT) and challenging localization of the hyper-functioning parathyroid glands.

Methods

We included 27 consecutive patients with primary HPT (19 F; median age: 58 years), with either (i) non-conclusive pre-surgical localization with 99mTc-sestaMIBI scintigraphy and neck ultrasonography (US), (ii) recurrence of previously operated HPT, or (iii) familiar HPT with a suspicion of multiple gland disease. Histological findings and resolution of HPT were considered as the gold standard.

Results

18F-FCH PET/CT was positive in 24/27 patients. Twenty-one patients underwent surgery with 27 resected lesions (14 adenomas, 11 hyperplastic glands, two hyper-functioning histologically normal glands), with resolution of HPT in 19/21 patients (90%). 18F-FCH PET/CT localized 22 lesions in 17/21 patients (per patient: sensitivity 81%, positive predictive value (PPV) 94%; per gland: sensitivity 76%, PPV 85%, specificity 91%, negative predictive value (NPV) 86%). 18F-FCH PET/CT found eight lesions which were undetectable on both 99mTc-sestaMIBI scintigraphy and US. In patients with a familial HPT and/or a multiple gland disease, sensitivity was 100 and 79% on a per-patient and a per-gland analysis respectively, while NPV was 63%. In six patients with a persistence or recurrence of previously treated HPT, 18F-FCH PET/CT localized all lesions, both in sporadic and familiar disease.

Conclusions

18F-FCH PET/CT is a promising modality in challenging pre-surgical localization of hyper-functioning parathyroid glands, such as inconclusive standard imaging, recurrence after surgery, or suspected multiple gland disease.
Literature
1.
2.
Iacobone M, Carnaille B, Palazzo FF, Vriens M. Hereditary hyperparathyroidism—a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg. 2015;400(8):867–86.CrossRefPubMed
3.
Bilezikian JP, et al. Guidelines for the management of asymptomatic primary hyperparathyroidism: summary statement from the Fourth International Workshop. J Clin Endocrinol Metab. 2014;99(10):3561–9.CrossRefPubMedPubMedCentral
4.
Khan AA, et al. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int. 2017;28(1):1.CrossRefPubMed
5.
Elaraj DM, et al. Are additional localization studies and referral indicated for patients with primary hyperparathyroidism who have negative sestamibi scan results? Arch Surg. 2010;145(6):578–81.CrossRefPubMed
6.
Kunstman JW, Kirsch JD, Mahajan A, Udelsman R. Parathyroid localization and implications for clinical management. J Clin Endocrinol Metab. 2013;98(3):902–12.CrossRefPubMed
7.
Taieb D, Hindie E, Grassetto G, Colletti PM, Rubello D. Parathyroid scintigraphy: when, how, and why? A concise systematic review. Clin Nucl Med. 2012;37(6):568–74.CrossRefPubMed
8.
Taillefer R, Boucher Y, Potvin C, Lambert R. Detection and localization of parathyroid adenomas in patients with hyperparathyroidism using a single radionuclide imaging procedure with technetium-99m-sestamibi (double-phase study). J Nucl Med. 1992;33(10):1801–7.PubMed
9.
Treglia G, et al. Detection rate of 99m Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: a meta-analysis. Head Neck. 2016;38(S1):E2159–72.CrossRefPubMed
10.
Caldarella C, Treglia G, Pontecorvi A, Giordano A. Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: a meta-analysis. Ann Nucl Med. 2012;26(10):794–803.CrossRefPubMed
11.
12.
Cheung K, Wang TS, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism. Ann Surg Oncol. 2012;19(2):577–83.CrossRefPubMed
13.
Abboud B, et al. Ultrasonography: highly accuracy technique for preoperative localization of parathyroid adenoma. Laryngoscope. 2008;118(9):1574–8.CrossRefPubMed
14.
Reeder SB, Desser TS, Weigel RJ, Jeffrey RB. Sonography in primary hyperparathyroidism. J Ultrasound Med. 2002;21(5):539–52.CrossRefPubMed
15.
Parikh PP, Farra JC, Allan BJ, Lew JI. Long-term effectiveness of localization studies and intraoperative parathormone monitoring in patients undergoing reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism. Am J Surg. 2015;210(1):117–22.CrossRefPubMed
16.
Shin JJ, Milas M, Mitchell J, Berber E, Ross L, Siperstein A. Impact of localization studies and clinical scenario in patients with hyperparathyroidism being evaluated for reoperative neck surgery. Arch Surg. 2011;146(12):1397–403.CrossRefPubMed
17.
Cazaentre T, Clivaz F, Triponez F. False-positive result in 18F-fluorocholine PET/CT due to incidental and ectopic parathyroid hyperplasia. Clin Nucl Med. 2014;39(6):e328–30.CrossRefPubMed
18.
Hodolic M, et al. Incidental uptake of 18F-fluorocholine (FCH) in the head or in the neck of patients with prostate cancer. Radiol Oncol. 2014;48(3):228.CrossRefPubMedPubMedCentral
19.
Mapelli P, et al. Incidental finding of parathyroid adenoma with 11C-choline PET/CT. Clin Nucl Med. 2012;37(6):593–5.CrossRefPubMed
20.
Quak E, Lheureux S, Reznik Y, Bardet S, Aide N. F18-choline, a novel PET tracer for parathyroid adenoma? J Clin Endocrinol Metab. 2013;98(8):3111–2.CrossRefPubMed
21.
Lezaic L, Rep S, Sever MJ, Kocjan T, Hocevar M, Fettich J. 18F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study. Eur J Nucl Med Mol Imaging. 2014;41(11):2083–9.CrossRefPubMed
22.
Michaud L, et al. A pilot comparison of 18F-fluorocholine PET/CT, ultrasonography and 123I/99mTc-sestaMIBI dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: influence of thyroid anomalies. Medicine (Baltimore). 2015;94(41):e1701.CrossRef
23.
Michaud L, et al. Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting Hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism? J Clin Endocrinol Metab. 2014;99(12):4531–6.CrossRefPubMed
24.
Hindié E, et al. 2009 EANM parathyroid guidelines. Eur J Nucl Med Mol Imaging. 2009;36(7):1201–16.CrossRefPubMed
25.
Kluijfhout WP, Vorselaars WMCM, Vriens MR, Borel Rinkes IHM, Valk GD, de Keizer B. Enabling minimal invasive parathyroidectomy for patients with primary hyperparathyroidism using Tc-99m-sestamibi SPECT–CT, ultrasound and first results of 18F-fluorocholine PET–CT. Eur J Radiol. 2015;84(9):1745–51.CrossRefPubMed
26.
Caron NR, Sturgeon C, Clark OH. Persistent and recurrent hyperparathyroidism. Curr Treat Options Oncol. 2004;5(4):335–45.CrossRefPubMed
27.
Wells SJ, Debenedetti M, Doherty G. Recurrent or persistent hyperparathyroidism. J Bone Min Res. 2002;17(Suppl 2):N158–62.
28.
Orevi M, Freedman N, Mishani E, Bocher M, Jacobson O, Krausz Y. Localization of parathyroid adenoma by 11C-choline PET/CT: preliminary results. Clin Nucl Med. 2014;39(12):1033–8.CrossRefPubMed
29.
Kluijfhout WP, et al. Fluorine-18 fluorocholine PET-CT localizes hyperparathyroidism in patients with inconclusive conventional imaging: a multicenter study from the Netherlands. Nucl Med Commun. 2016;37(12):1246–52.CrossRefPubMed
30.
31.
M. Hocevar, et al. Focused parathyroidectomy without intraoperative parathormone testing is safe after pre-operative localization with 18F-Fluorocholine PET/CT. Eur J Surg Oncol. 2017;43(1):133–7.CrossRefPubMed
32.
Deandreis D, et al. 18Fluorocholine PET/CT in parathyroid carcinoma: a new tool for disease staging? Eur J Nucl Med Mol Imaging. 2015;42(12):1941–2.CrossRefPubMed
33.
Krakauer M, Wieslander B, Myschetzky PS, Lundstrøm A, Bacher T, Sørensen CH, et al. A prospective comparative study of parathyroid dual-phase scintigraphy, dual-isotope subtraction scintigraphy, 4D-CT, and ultrasonography in primary hyperparathyroidism. Clin Nucl Med. 2016;41:93–100.CrossRefPubMed
34.
Caldarella C, Treglia G, Isgrò MA, Giordano A. Diagnostic performance of positron emission tomography using 11C-methionine in patients with suspected parathyroid adenoma: a meta-analysis. Endocrine. 2013;43(1):78–83.CrossRefPubMed
35.
Merchavy S, Luckman J, Guindy M, Segev Y, Khafif A. 4D MRI for the localization of parathyroid adenoma: a novel method in evolution. Otolaryngol Head Neck Surg. 2016;154(3):446–8.CrossRefPubMed
36.
Sacconi B, et al. MR appearance of parathyroid adenomas at 3 T in patients with primary hyperparathyroidism: what radiologists need to know for pre-operative localization. Eur Radiol. 2016;26(3):664–73.CrossRefPubMed
Metadata
Title
Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-Fluorocholine PET/CT
Authors
Serena Grimaldi
Jacques Young
Peter Kamenicky
Dana Hartl
Marie Terroir
Sophie Leboulleux
Amandine Berdelou
Julien Hadoux
Segolene Hescot
Hervé Remy
Eric Baudin
Martin Schlumberger
Désirée Deandreis
Publication date
01-09-2018
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2018
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-018-4018-z

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