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- Title
Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of <sup>18</sup>F-Fluorocholine PET/CT.
- Authors
Grimaldi, Serena; Young, Jacques; Kamenicky, Peter; Hartl, Dana; Terroir, Marie; Leboulleux, Sophie; Berdelou, Amandine; Hadoux, Julien; Hescot, Segolene; Remy, Hervé; Baudin, Eric; Schlumberger, Martin; Deandreis, Désirée
- 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.
- Subjects
DIAGNOSTIC imaging; PARATHYROID glands; HYPERPARATHYROIDISM; POSITRON emission tomography; COMPUTED tomography; PARATHYROID gland cancer; DIAGNOSIS; PATIENTS
- Publication
European Journal of Nuclear Medicine & Molecular Imaging, 2018, Vol 45, Issue 10, p1772
- ISSN
1619-7070
- Publication type
Article
- DOI
10.1007/s00259-018-4018-z