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van der Zant FM, Wondergem M, Broos WAM, Lazarenko SV, Knol RJJ. Frequency and characteristics of ectopic parathyroid adenomas in a cohort of patients referred for 18 F-fluorocholine PET/CT. Nucl Med Commun 2025; 46:89-94. [PMID: 39434614 DOI: 10.1097/mnm.0000000000001920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2024]
Abstract
AIM This article aimed to study the frequency and characteristics of ectopic/intrathyroidal parathyroid adenomas in patients referred for 18 F-fluorocholine PET/computed tomography (CT). PATIENTS AND METHODS From 11 June 2015 to 15 January 2024, 729 patients were studied. Recorded patient variables included hyperparathyroidism type, sex, age, presence of symptoms, renal involvement, bone involvement, parathyroid hormone (PTH), and serum calcium, phosphate, and vitamin D as well as 24-h urine calcium excretion. PET/CT results were also collected. In case of parathyroidectomy, the weight of the adenomas was recorded. Continuous variables were expressed as mean ± SD. Differences were evaluated with Mann-Whitney U -tests or two-sample t -tests, when appropriate. P -values ≤0.05 were considered statistically significant. RESULTS PET/CT showed no adenoma in 163 (22%), adenoma in 451 (62%), hyperplasia/multiglandular disease in 32 (4%), and equivocal results in 83 (11%) patients. A total of 6/729 (1%) adenomas were located intrathyroidally and 16/729 (2%) had an ectopic location. Patients with ectopic/intrathyroidal adenoma showed significantly higher serum PTH levels than patients with no visualization of adenoma on PET. The mean mass of the adenoma was 1 ± 2.3 g in patients with orthotopic adenomas versus 2.7 ± 3.3 g in patients with ectopic/intrathyroidal adenomas; however, this was not significantly different ( P = 0.09). CONCLUSION In the presented cohort, the frequency of ectopic/intrathyroidal parathyroid adenomas was 3%. No significant difference in weight was found between orthotopic and ectopic/intrathyroidal parathyroid adenomas.
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Affiliation(s)
| | | | - Wouter A M Broos
- Department of Nuclear Medicine, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | | | - Remco J J Knol
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar
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Rep S, Sirca K, Lezaic EM, Zaletel K, Hocevar M, Lezaic L. [ 18F]fluorocholine PET vs. [ 99mTc]sestamibi scintigraphy for detection and localization of hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: outcomes and resource efficiency. Radiol Oncol 2024; 58:486-493. [PMID: 39608010 PMCID: PMC11604255 DOI: 10.2478/raon-2024-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/24/2024] [Indexed: 11/30/2024] Open
Abstract
BACKGROUND Minimally invasive parathyroidectomy is the treatment of choice in patients with primary hyperparathyroidism (PHP), but it needs a reliable preoperative localization method to detect hyperfunctioning parathyroid tissue. Higher sensitivity and lower radiation exposure was demonstrated for [18F]fluorocholine PET/CT (FCh-PET/CT) in comparison to [99mTc]sestamibi (MIBI) scintigraphy. However, data of its efficiency in resource use and patient outcomes is lacking. The aim of our study was to determine the resource efficiency and patient outcomes of FCh-PET/CT in comparison to conventional MIBI scintigraphy. PATIENTS AND METHODS A group of 234 patients who underwent surgery after MIBI scintigraphy was compared to a group of 163 patients who underwent surgery after FCh-PET/CT. The whole working process from the implementation of imaging to the completion of surgical treatment was analyzed. The economic burden was expressed in the time needed for the required procedures. RESULTS The time needed to perform imaging was reduced by 83% after FCh-PET/CT in comparison to MIBI scintigraphy. The time needed to perform surgery was reduced by 41% when intraoperative parathyroid hormone monitoring was not used. There was no significant difference in the time of surgery between FCh-PET/CT and MIBI scintigraphy. CONCLUSIONS FCh-PET/CT reduces the time of imaging, the time of surgery and potentially reduces the number of reoperations for persistent disease.
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Affiliation(s)
- Sebastijan Rep
- Division of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Imaging and Radiotherapy Department, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Klara Sirca
- Department of Oncological Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ema Macek Lezaic
- Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Zaletel
- Division of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Hocevar
- Department of Oncological Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Lezaic
- Division of Nuclear Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Noskovicova L, Balogova S, Aveline C, Tassart M, Zhang-Yin J, Kerrou K, Jaksic I, Montravers F, Talbot JN. 18F-Fluorocholine-Positron Emission Tomography/Computerized Tomography (FCH PET/CT) Imaging for Detecting Abnormal Parathyroid Glands: Indication, Practice, Interpretation and Diagnostic Performance. Semin Nucl Med 2024; 54:875-895. [PMID: 39306520 DOI: 10.1053/j.semnuclmed.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Accepted: 08/17/2024] [Indexed: 11/19/2024]
Abstract
In patients with confirmed hyperparathyroidism (HPT) scheduled for surgical treatment, the preoperatory imaging permits to optimize the operatory protocol of parathyroidectomy (PTX), in particular by selecting those patients who can benefit from minimally invasive PTX (MIPTX). The MIPTX has the merit to shorten the operative time, incision length, and to reduce the operatory risks. With preoperative localization studies, the rate of PTX failure, in particular due to nonsuspected multiglandular or ectopic disease, has been profoundly decreased. The first cases of incidental localization of abnormal parathyroid glands (PTs) on FCH PET/CTs performed for another indication were reported more than one decade ago. Since then, significant amount of data from heterogeneous series of patients consistently confirmed better diagnostic performances of FCH PET/CT (sensitivity for detection of abnormal PT 97%, range 96%-98%) in comparison with other radiopharmaceuticals, ultrasonography or 4D-CeCT in localizing hyperfunctioning parathyroid glands (HFPTGs) in case of primary HPT. Utility of FCH PET/CT in case of renal HPT has been reported in fewer series. The article discusses and summarizes the bibliographic evidence on documented indications of FCH PET/CT in patients with HPT, its safety profile, the practice of FCH PET/CT and interpretation of FCH PET/CT findings, including potential interpretation pitfalls and tips to avoid them. Our real-world experience over 12 years reinforces published evidence supporting the use of FCH PET/CT as the first-line radionuclide imaging technique in patients with all types of HPT in whom surgery is an option.
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Affiliation(s)
- Lucia Noskovicova
- Department of Nuclear medicine, Comenius University Bratislava, St. Elisabeth Oncology Institute and Bory Hospital a.s., Bratislava, Slovakia
| | - Sona Balogova
- Department of Nuclear medicine, Comenius University Bratislava, St. Elisabeth Oncology Institute and Bory Hospital a.s., Bratislava, Slovakia; Service de médecine nucléaire, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Cyrielle Aveline
- Service de médecine nucléaire, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Tassart
- Service de radiologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jules Zhang-Yin
- Department of Nuclear Medicine, Clinique Sud Luxembourg, Arlon, Belgium
| | - Khaldoun Kerrou
- Service de médecine nucléaire, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Ivan Jaksic
- Department of Nuclear medicine, Comenius University Bratislava and Bory Hospital a.s., Bratislava, Slovakia
| | - Françoise Montravers
- Service de médecine nucléaire, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Noël Talbot
- Service de médecine nucléaire, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Institut National des Sciences et Techniques Nucléaires (INSTN), Saclay, France
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van Mossel S, Saing S, Appelman-Dijkstra N, Quak E, Schepers A, Smit F, de Geus-Oei LF, Vriens D. Cost-effectiveness of one-stop-shop [ 18F]Fluorocholine PET/CT to localise parathyroid adenomas in patients suffering from primary hyperparathyroidism. Eur J Nucl Med Mol Imaging 2024; 51:3585-3595. [PMID: 38837058 PMCID: PMC11457719 DOI: 10.1007/s00259-024-06771-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/11/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE We conducted a cost-effectiveness analysis in which we compared a preoperative [18F]Fluorocholine PET/CT-based one-stop-shop imaging strategy with current best practice in which [18F]Fluorocholine PET/CT is only recommended after negative or inconclusive [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT for patients suffering from primary hyperparathyroidism. We investigated whether the one-stop-shop strategy performs as well as current best practice but at lower costs. METHODS We developed a cohort-level state transition model to evaluate both imaging strategies respecting an intraoperative parathyroid hormone monitored treatment setting as well as a traditional treatment setting. The model reflects patients' hospital journeys after biochemically diagnosed primary hyperparathyroidism. A cycle length of twelve months and a lifetime horizon were used. We conducted probabilistic analyses simulating 50,000 cohorts to assess joint parameter uncertainty. The incremental net monetary benefit and cost for each quality-adjusted life year were estimated. Furthermore, threshold analyses regarding the tariff of [18F]Fluorocholine PET/CT and the sensitivity of [99mTc]Tc-methoxy isobutyl isonitrile SPECT/CT were performed. RESULTS The simulated long-term health effects and costs were similar for both imaging strategies. Accordingly, there was no incremental net monetary benefit and the one-stop-shop strategy did not result in lower costs. These results applied to both treatment settings. The threshold analysis indicated that a tariff of €885 for [18F]Fluorocholine PET/CT was required to be cost-effective compared to current best practice. CONCLUSION Both preoperative imaging strategies can be used interchangeably. Daily clinical practice grounds such as available local resources and patient preferences should inform policy-making on whether a hospital should implement the one-stop-shop imaging strategy.
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Affiliation(s)
- Sietse van Mossel
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
- Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
| | - Sopany Saing
- Faculty of Behavioural Management and Social Sciences, Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Natasha Appelman-Dijkstra
- Department of Internal Medicine, Division Endocrinology, Leiden University Medical Centre, Leiden, The Netherlands
- Centre for Bone Quality Leiden, Leiden University Medical Centre, Leiden, The Netherlands
| | - Elske Quak
- Department of Nuclear Medicine, Centre François Baclesse, Caen, France
| | - Abbey Schepers
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Frits Smit
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Radiology, Section Nuclear Medicine, Alrijne Medical Centre, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
- Department of Radiation Sciences and Technology, Delft University of Technology, Delft, The Netherlands
| | - Dennis Vriens
- Department of Radiology, Section Nuclear Medicine, Leiden University Medical Centre, Leiden, The Netherlands
- Centre for Bone Quality Leiden, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Medical Imaging, Radboud University Medical Centre, Nijmegen, The Netherlands
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5
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Quak E, Lasne-Cardon A, Cavarec M, Lireux B, Bastit V, Roudaut N, Salaun PY, Keromnes N, Potard G, Vaduva P, Esvant A, Jegoux F, de Crouy-Chanel O, Devillers A, Guery C, Lasnon C, Ciappuccini R, Legrand B, Estienne A, Christy F, Grellard JM, Bardet S, Clarisse B. F18-Choline PET/CT or MIBI SPECT/CT in the Surgical Management of Primary Hyperparathyroidism: A Diagnostic Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024; 150:658-665. [PMID: 38900416 PMCID: PMC11190825 DOI: 10.1001/jamaoto.2024.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/18/2024] [Indexed: 06/21/2024]
Abstract
Importance Whether F18-choline (FCH) positron emission tomographic (PET)/computed tomographic (CT) scan can replace Tc99m-sestaMIBI (MIBI) single-photon emission (SPE)CT/CT as a first-line imaging technique for preoperative localization of parathyroid adenomas (PTA) in patients with primary hyperparathyroidism (PHPT) is unclear. Objective To compare first-line FCH PET/CT vs MIBI SPECT/CT for optimal care in patients with PHPT needing parathyroidectomy and to compare the proportions of patients in whom the first-line imaging method resulted in successful minimally invasive parathyroidectomy (MIP) and normalization of calcemia 1 month after surgery. Design, Setting, and Participants A French multicenter randomized open diagnostic intervention phase 3 trial was conducted. Patients were enrolled from November 2019 to May 2022 and participated up to 6 months after surgery. The study included adults with PHPT and an indication for surgical treatment. Patients with previous parathyroid surgery or multiple endocrine neoplasia type 1 (MEN1) were ineligible. Interventions Patients were assigned in a 1:1 ratio to receive first-line FCH PET/CT (FCH1) or MIBI SPECT/CT (MIBI1). In the event of negative or inconclusive first-line imaging, they received second-line FCH PET/CT (FCH2) after MIBI1 or MIBI SPECT/CT (MIBI2) after FCH1. All patients underwent surgery under general anesthesia within 12 weeks following the last imaging. Clinical and biologic (serum calcemia and parathyroid hormone levels) assessments were performed 1 and 6 months after surgery. Main Outcomes and Measures The primary outcome was a true-positive first-line imaging-guided MIP combined with uncorrected serum calcium levels of 2.55 mmol/l or less 1 month after surgery, corresponding to the local upper limit of normality. Results Overall, 57 patients received FCH1 (n = 29) or MIBI1 (n = 28). The mean (SD) age of patients was 62.8 (12.5) years with 15 male (26%) and 42 female (74%) patients. Baseline patient characteristics were similar between groups. Normocalcemia at 1 month after positive first-line imaging-guided MIP was observed in 23 of 27 patients (85%) in the FCH1 group and 14 of 25 patients (56%) in the MIBI1 group. Sensitivity was 82% (95% CI, 62%-93%) and 63% (95% CI, 42%-80%) for FCH1 and MIBI1, respectively. Follow-up at 6 months with biochemical measures was available in 43 patients, confirming that all patients with normocalcemia at 1 month after surgery still had it at 6 months. No adverse events related to imaging and 4 adverse events related to surgery were reported. Conclusions This randomized clinical trial found that first-line FCH PET/CT is a suitable and safe replacement for MIBI SPECT/CT. FCH PET/CT leads more patients with PHPT to correct imaging-guided MIP and normocalcemia than MIBI SPECT/CT thanks to its superior sensitivity. Trial Registration ClinicalTrials.gov Identifier: NCT04040946.
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Affiliation(s)
- Elske Quak
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | | | - Marie Cavarec
- Department of Head & Neck Surgery, University Hospital of Caen, Caen France
| | - Barbara Lireux
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Vianney Bastit
- Department of Head & Neck Surgery, Centre François Baclesse, Caen, France
- Department of Head & Neck Surgery, University Hospital of Caen, Caen France
| | - Nathalie Roudaut
- Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Pierre-Yves Salaun
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
- EA 3878, University of Bretagne Occidentale, Brest, France
| | - Nathalie Keromnes
- Department of Nuclear Medicine, University Hospital of Brest, Brest, France
| | - Gaël Potard
- Department of Head & Neck Surgery, University Hospital of Brest, France
| | - Patricia Vaduva
- Department of Endocrinology, University Hospital of Rennes, Rennes, France
| | - Annabelle Esvant
- Department of Endocrinology, University Hospital of Rennes, Rennes, France
| | - Franck Jegoux
- ENT Department, Rennes University Medical Center, Rennes, France
| | | | - Anne Devillers
- Department of Nuclear Medicine, Eugene Marquis Cancer Institute, Rennes, France
| | - Clémence Guery
- Department of Nuclear Medicine, Eugene Marquis Cancer Institute, Rennes, France
| | - Charline Lasnon
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
| | - Bérénice Legrand
- Clinical Research Department, Centre François Baclesse, Caen, France
| | - Adrien Estienne
- Clinical Research Department, Centre François Baclesse, Caen, France
| | - François Christy
- Clinical Research Department, Centre François Baclesse, Caen, France
| | | | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Caen, France
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Chakrabarty N, Mahajan A, Basu S, D’Cruz AK. Imaging Recommendations for Diagnosis and Management of Primary Parathyroid Pathologies: A Comprehensive Review. Cancers (Basel) 2024; 16:2593. [PMID: 39061231 PMCID: PMC11274996 DOI: 10.3390/cancers16142593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/06/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Parathyroid pathologies are suspected based on the biochemical alterations and clinical manifestations, and the predominant roles of imaging in primary hyperparathyroidism are localisation of tumour within parathyroid glands, surgical planning, and to look for any ectopic parathyroid tissue in the setting of recurrent disease. This article provides a comprehensive review of embryology and anatomical variations of parathyroid glands and their clinical relevance, surgical anatomy of parathyroid glands, differentiation between multiglandular parathyroid disease, solitary adenoma, atypical parathyroid tumour, and parathyroid carcinoma. The roles, advantages and limitations of ultrasound, four-dimensional computed tomography (4DCT), radiolabelled technetium-99 (99mTc) sestamibi or dual tracer 99mTc pertechnetate and 99mTc-sestamibi with or without single photon emission computed tomography (SPECT) or SPECT/CT, dynamic enhanced magnetic resonance imaging (4DMRI), and fluoro-choline positron emission tomography (18F-FCH PET) or [11C] Methionine (11C -MET) PET in the management of parathyroid lesions have been extensively discussed in this article. The role of fluorodeoxyglucose PET (FDG-PET) has also been elucidated in this article. Management guidelines for parathyroid carcinoma proposed by the American Society of Clinical Oncology (ASCO) have also been described. An algorithm for management of parathyroid lesions has been provided at the end to serve as a quick reference guide for radiologists, clinicians and surgeons.
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Affiliation(s)
- Nivedita Chakrabarty
- Department of Radiodiagnosis, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, 65 Pembroke Place, Liverpool L7 8YA, UK
- Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Hospital Annexe, Homi Bhabha National Institute (HBNI), Parel, Mumbai 400012, Maharashtra, India;
| | - Anil K. D’Cruz
- Apollo Hospitals, Navi Mumbai 400614, Maharashtra, India;
- Foundation of Head Neck Oncology, Mumbai 400012, Maharashtra, India
- Union International Cancer Control (UICC), 1202 Geneva, Switzerland
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Ferrari SB, Morand GB, Rupp NJ, Krützfeldt J, Vetter D, Hüllner MW, Broglie MA. Clinical predictors of negative/equivocal SPECT imaging outcomes in primary hyperparathyroidism: Factors calling for 18F-choline-PET. Am J Otolaryngol 2024; 45:104315. [PMID: 38701728 DOI: 10.1016/j.amjoto.2024.104315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/15/2024] [Indexed: 05/05/2024]
Abstract
PURPOSE For minimally invasive surgery of parathyroid adenomas, exact localization diagnostics are essential. Main imaging modalities used for diagnostics are sonography, SPECT with/without CT (traditional imaging) and 18F-choline-PET. The aim of our study was to identify predictors for inconclusive SPECT imaging and subsequently determine in which cases 18F-choline-PET is needed. METHODS Retrospective analysis of 138 patients with histologically confirmed primary hyperparathyroidism (pHPT). After sonography, patients underwent SPECT or SPECT/CT imaging, with subsequent 18F-choline-PET in cases of disconcordant results. Logistic regression analysis was used to identify clinical and laboratory factors predictive for negative SPECT results. RESULTS Sensitivity rates for sonography, SPECT, SPECT/CT, and choline-PET were 47 %, 49 %, 71.7 %, and 97 %, respectively. Logistic regression revealed lower PTH levels (p < 0.001), presence of structural thyroid disease (p = 0.018), and negative sonography (p < 0.001) as predictive of negative/equivocal SPECT outcome. An additional traditional imaging CT scan to a SPECT enhanced detection odds, as did greater adenoma weight. Urolithiasis, osteoporosis, and calcium values as measurement of activity and duration of disease showed no significant association with the detection rate. Furthermore, our study demonstrated that 18F-choline-PET exhibited remarkable sensitivity in detecting adenomas among patients with negative/equivocal SPECT results. CONCLUSION Our study reveals potential predictive factors for a negative/equivocal SPECT outcome in pHPT. Identifying these factors might allow minimizing futile SPECT examinations and perhaps encourage timely utilization of 18F-choline-PET imaging. Our study reinforces the clinical significance of 18F-choline-PET, especially in complex cases with disconcordant results by conventional parathyroid imaging methods.
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Affiliation(s)
- Sabina B Ferrari
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland.
| | - Grégoire B Morand
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland; University of Zurich, Switzerland; Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Niels J Rupp
- University of Zurich, Switzerland; Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland
| | - Jan Krützfeldt
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Switzerland
| | - Diana Vetter
- Department of Visceral Surgery and Transplantation, University Hospital of Zurich, Switzerland
| | - Martin W Hüllner
- University of Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Switzerland
| | - Martina A Broglie
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland
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8
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Schouw HM, Noltes ME, Brouwers AH, Nilsson IL, Zedenius J, Kruijff S. How nuclear imaging changed parathyroid surgical strategies through time. Eur J Nucl Med Mol Imaging 2024; 51:2165-2171. [PMID: 38649491 DOI: 10.1007/s00259-024-06707-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- H M Schouw
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - M E Noltes
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Department of Surgery, Martini Hospital, Groningen, Netherlands
| | - A H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - I-L Nilsson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - J Zedenius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - S Kruijff
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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9
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Krol JP, Joosten FBM, de Boer H, Bernsen MLE, Slump CH, Oyen WJG. Four-dimensional computed tomography as first-line imaging in primary hyperparathyroidism, a retrospective comparison to conventional imaging in a predominantly single adenoma population. EJNMMI REPORTS 2024; 8:11. [PMID: 38748330 PMCID: PMC11061064 DOI: 10.1186/s41824-024-00198-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/24/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND To determine the use of four-dimensional CT as first-line imaging compared to the traditional combination of ultrasound and [99mTc]Tc-Sestamibi SPECT. MATERIALS AND METHODS Retrospective review of preoperative imaging in patients with primary hyperparathyroidism, who underwent parathyroidectomy between 2012 and 2021. In one group, the combination ultrasound and [99mTc]Tc-Sestamibi SPECT was used as first-line imaging (n = 54), in the other group four-dimensional CT was the first-line imaging modality (n = 51). Sensitivity and positive predictive value were calculated on patient, lateralisation and localisation level. The need for additional imaging was also assessed for both groups. RESULTS Four-dimensional CT had a significantly higher sensitivity compared to the combination of ultrasound/[99mTc]Tc-Sestamibi SPECT on patient and localisation level (70.6% vs. 51.9%, p = 0.049 and 60.8% vs. 35.2%, p = 0.009 respectively). Sensitivity for lateralisation also appeared higher, but did not reach significance (62.7% vs. 44.4%, p = 0.060). Positive predictive value was not significantly higher for four-dimensional CT compared to ultrasound and [99mTc]Tc-Sestamibi SPECT (88.9% vs. 85.7% for lateralisation and 86.1% vs. 67.9% for localisation respectively). Additional imaging was required in 14 patients with four-dimensional CT as first-line imaging (27.4%) consisting of 2 ultrasound/[99mTc]Tc-Sestamibi SPECT and 13 [18F]fluorocholine PET/CT, compared to 24 patients with ultrasound/[99mTc]Tc-Sestamibi SPECT as first-line imaging (44.4%), requiring 22 four-dimensional CT and 9 [18F]fluorocholine PET/CT. CONCLUSIONS Four-dimensional CT as the sole first-line parathyroid imaging modality had higher sensitivity than the combination of ultrasound and [99mTc]Tc-Sestamibi SPECT, therefore requiring fewer additional procedures. Although the most costly, [18F]fluorocholine PET/CT was the most effective technique to localise parathyroid adenoma in case all other imaging was negative.
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Affiliation(s)
- Jorian P Krol
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815AD, The Netherlands.
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, University of Twente, Enschede, The Netherlands.
| | - Frank B M Joosten
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815AD, The Netherlands
| | - Hans de Boer
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Marie Louise E Bernsen
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815AD, The Netherlands
| | - Cornelis H Slump
- Department of Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Sciences, University of Twente, Enschede, The Netherlands
| | - Wim J G Oyen
- Department of Radiology & Nuclear Medicine, Rijnstate Hospital, Wagnerlaan 55, Arnhem, 6815AD, The Netherlands
- Department of Biomedical Sciences and Humanitas Clinical and Research Centre, Department of Nuclear Medicine, Humanitas University, Milan, Italy
- Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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10
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Boucher A, Delabie J, Lussey-Lepoutre C, Haissaguerre M, Ouvrard E, Lavinia V, Le Bras M, Batisse-Lignier M, Cuny T, Jacquet-Francillon N, Gaujoux S, Molina O, Imperiale A, Latge A, Ansquer C, Kelly A, Borson-Chazot F, Tlili G, Sebag F, Hamidou Z, Romanet P, Taïeb D. Performance of [ 18F]fluorocholine PET/CT in MEN1-related primary hyperparathyroidism before initial surgery or for persistent/recurrent disease. Eur J Nucl Med Mol Imaging 2024; 51:1349-1360. [PMID: 38057652 DOI: 10.1007/s00259-023-06537-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE The aims of the study were to evaluate the performance and robustness of [18F]fluorocholine PET/CT in detecting hyperfunctioning parathyroid glands in MEN1-related primary hyperparathyroidism (pHPT) at different stages of their disease. METHODS Retrospective French multicenter study including patients with MEN1 pHPT who underwent [18F]fluorocholine PET/CT at initial diagnosis or for evaluation of persistent/recurrent disease. PET/CT were independently reviewed by two readers in a blinded manner. The assessment of PET/CT on a per-patient basis was assessed using a comprehensive set of criteria that considered pathological findings or agreement with alternative diagnostic methods in non-operated patients. The secondary objectives included the analysis of the performance of PET/CT at a per-lesion level, with reference to a pathological Gold Standard, and examining its interobserver reproducibility. RESULTS A total of 71 MEN1 patients were included (73 PET/CT) in the study. At the per-patient level (entire cohort), [18F]fluorocholine PET/CT sensitivity ranged from 98.5 to 100% among the different readers. An average of 1.77 glands per PET was described, with 2.35 glands at the initial diagnosis (n = 23) and 1.5 in previously operated cases (n = 50). PET/CT detected more lesions than conventional imaging work-up (neck ultrasound and/or scintigraphy). At the per-lesion level (41 operated patients), sensitivity ranged across different readers from 84.4 to 87%, and specificity ranged from 94.7 to 98.8%. At initial diagnosis, all patients that exhibited 3 or more abnormal glands on PET underwent subtotal parathyroidectomy while 7 out of 13 patients with 1 or 2 gland abnormalities on PET underwent less than subtotal parathyroidectomy. Finally, the degree of inter-observer agreement was high. CONCLUSION [18F]fluorocholine PET/CT is a reliable and robust imaging modality for the evaluation of MEN1-related pHPT and could guide surgeons in achieving the optimal benefit-risk ratio. This study gives a great impetus for its adoption as a primary diagnostic tool in this context.
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Affiliation(s)
- Aymeric Boucher
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Julia Delabie
- Department of Endocrinology, Hôpital Louis Pradel, Hospices Civils de Lyon and Claude Bernard Lyon 1 University, Lyon, France
| | | | - Magalie Haissaguerre
- Department of Endocrinology and Endocrine Oncology, Haut Leveque Hospital, University Hospital of Bordeaux, Pessac, France
| | - Eric Ouvrard
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Vija Lavinia
- Department of Nuclear Medicine, Oncopole Claudius Regaud, Toulouse, France
| | - Maëlle Le Bras
- Department of Endocrinology, Diabetology and Nutrition, L'institut du Thorax, CHU Nantes, 44000, Nantes, France
| | | | - Thomas Cuny
- Department of Endocrinology, Conception Hospital, Aix-Marseille University, Marseille, France
| | - Nicolas Jacquet-Francillon
- Department of Nuclear Medicine, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Sud Hospital, Pierre-Bénite, Lyon, France
| | - Sébastien Gaujoux
- Department of General, Visceral, and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Paris Sorbonne Université, Paris, France
| | - Océane Molina
- Department of Endocrinology and Endocrine Oncology, Haut Leveque Hospital, University Hospital of Bordeaux, Pessac, France
| | - Alessio Imperiale
- Department of Nuclear Medicine and Molecular Imaging, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg, France
| | - Adrien Latge
- Department of Nuclear Medicine, Oncopole Claudius Regaud, Toulouse, France
| | - Catherine Ansquer
- Department of Nuclear Medicine, CHU Nantes, Nantes Université, 44000, Nantes, France
| | - Antony Kelly
- Department of Nuclear Medicine, Centre Jean Perrin, Clermont-Ferrand, France
| | - Françoise Borson-Chazot
- Department of Endocrinology, Hôpital Louis Pradel, Hospices Civils de Lyon and Claude Bernard Lyon 1 University, Lyon, France
| | - Ghoufrane Tlili
- Department of Nuclear Medicine, Bordeaux University and Hospitals, 33604, Bordeaux, France
| | - Frédéric Sebag
- Department of Endocrine Surgery, Aix-Marseille University, Conception Hospital, Marseille, France
| | - Zeinab Hamidou
- Department of Public Health, Aix-Marseille University, Marseille, France
| | - Pauline Romanet
- Laboratory of Molecular Biology Hospital La Timone, Aix Marseille Univ, APHM, INSERM, MMG, Marseille, France
| | - David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 Rue Saint-Pierre, 13385, Marseille, France.
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11
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Noltes ME, Kruijff S, Appelman APA, Jansen L, Zandee WT, Links TP, van Hemel BM, Schouw HM, Dierckx RAJO, Francken AB, Kelder W, van der Hoorn A, Brouwers AH. Head-to-head comparison of [ 11C]methionine PET, [ 11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism. Eur J Nucl Med Mol Imaging 2024; 51:1050-1059. [PMID: 37975887 PMCID: PMC10881780 DOI: 10.1007/s00259-023-06488-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [11C]methionine PET/CT, [11C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan. METHODS We conducted a powered, prospective, blinded cohort study in patients with biochemically proven pHPT and prior negative or discordant first-line imaging consisting of ultrasonography and 99mTc-sestamibi. All patients underwent [11C]methionine PET/CT, [11C]choline PET/CT, and 4D-CT. At first, all scans were interpreted by a nuclear medicine physician, and a radiologist who were blinded from patient data and all imaging results. Next, a non-blinded scan reading was performed. The scan results were correlated with surgical and histopathological findings. Serum calcium values at least 6 months after surgery were used as gold standard for curation of HPT. RESULTS A total of 32 patients were included in the study. With blinded evaluation, [11C]choline PET/CT was positive in 28 patients (88%), [11C]methionine PET/CT in 23 (72%), and 4D-CT in 15 patients (47%), respectively. In total, 30 patients have undergone surgery and 32 parathyroid lesions were histologically confirmed as parathyroid adenomas. Based on the blinded evaluation, lesion-based sensitivity of [11C]choline PET/CT, [11C]methionine PET/CT, and 4D-CT was respectively 85%, 67%, and 39%. The sensitivity of [11C]choline PET/CT differed significantly from that of [11C]methionine PET/CT and 4D-CT (p = 0.031 and p < 0.0005, respectively). CONCLUSION In the setting of pHPT with negative first-line imaging, [11C]choline PET/CT is superior to [11C]methionine PET/CT and 4D-CT in localizing parathyroid adenomas, allowing correct localization in 85% of adenomas. Further studies are needed to determine cost-benefit and efficacy of these scans, including the timing of these scans as first- or second-line imaging techniques.
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Affiliation(s)
- Milou E Noltes
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Schelto Kruijff
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Auke P A Appelman
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Liesbeth Jansen
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Wouter T Zandee
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thera P Links
- Division of Endocrinology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bettien M van Hemel
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Hugo M Schouw
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgical Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | | | - Wendy Kelder
- Department of Surgery, Martini Hospital Groningen, Groningen, the Netherlands
| | - Anouk van der Hoorn
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
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12
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Aphale R, Dharmashaktu Y, Damle NA, Singareddy CR, Behera A, Wakankar R, Kumar P, Bal C, Khadgawat R, Chumber S. Odd Sites of Parathyroid Adenomas: 18F-fluorocholine PET/CT Pointing to the Right Place. Indian J Nucl Med 2024; 39:123-125. [PMID: 38989306 PMCID: PMC11232731 DOI: 10.4103/ijnm.ijnm_13_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/13/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2024] Open
Abstract
Primary hyperparathyroidism is mostly caused by parathyroid adenoma(s) which are generally localized using routine imaging modalities such as neck ultrasonography and 99mTc-SestaMIBI scintigraphy. However, these can miss ectopic parathyroid adenomas due to their limited sensitivities. These ectopic lesions can later lead to failure of surgical excision and necessitate the need for a re-exploration. 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) can help in the localization of these ectopic adenomas due to its superior detection rates and spatial resolution. Herein, we report a case of ectopic parathyroid adenomas that were localized on FCH PET/CT.
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Affiliation(s)
- Rijuta Aphale
- Department of Surgery, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Yamini Dharmashaktu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Nishikant Avinash Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Chandrateja Reddy Singareddy
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Abhishek Behera
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Ritwik Wakankar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Praveen Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
| | - Sunil Chumber
- Department of Surgery, All India Institute of Medical Sciences, National Capital Region, New Delhi, India
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13
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Wakankar R, Dharmashaktu Y, Damle AN, Kumar P, Bal C, Kumar R, Tripathi M, Agarwal S, Khadgawat R, Chumber S, Kumar C. Role of 18Fluorocholine Positron Emission Tomography/Computed Tomography in the Localization of Culprit Lesions in Patients of Persistent/Recurrent Primary Hyperparathyroidism: A Prospective Study in COVID Times. Indian J Nucl Med 2023; 38:218-223. [PMID: 38046977 PMCID: PMC10693358 DOI: 10.4103/ijnm.ijnm_31_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 01/20/2023] [Accepted: 01/25/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Recurrent/persistent primary hyperparathyroidism in patients who have undergone previous parathyroidectomy is a challenging condition. Imaging is important for localizing the parathyroid adenoma for re-exploration and 18F-Fluorocholine (18F-FCH) positron emission tomography/computed tomography (PET/CT) seems ideal for this purpose. Aim This prospective study attempted to ascertain the utility of 18F-FCH PET/CT as an investigation in preoperative localization of abnormal parathyroid tissue in recurrent/persistent primary hyperparathyroidism while comparing it with 99mTc-Sestamibi dual-phase scintigraphy with early single-photon emission CT (SPECT)/CT and neck ultrasonography (USG). Methods Twenty patients with biochemical features of recurrent/persistent primary hyperparathyroidism were enrolled into this study. They underwent neck USG, 99mTc-Sestamibi dual-phase scintigraphy with early SPECT/CT and 18F-FCH PET/CT for localization of parathyroid lesions. Six patients underwent surgical resection of the detected lesions, 3 were awaiting surgery, and 11 were managed conservatively. One patient died due to COVID. Results The calculated positive predictive values on a per-lesion basis of neck USG, 99mTc-sestamibi scintigraphy and early SPECT/CT and 18F-FCH PET/CT in the cohort of the 5 operated patients were 75% (3/4), 71.4% (5/7), and 71.4% (5/7), respectively. On a per-patient basis, the lesion detection rate was 100% for 99mTc-sestamibi scan and FCH PET (5/5) and 80% on neck USG (4/5). Conclusion 18F-FCH PET/CT is a highly accurate imaging modality for the detection of parathyroid lesions in patients with recurrent/persistent primary hyperparathyroidism.
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Affiliation(s)
- Ritwik Wakankar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yamini Dharmashaktu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - A. Nishikant Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chitresh Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
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14
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Abhishek B, Wakankar R, Dharmashaktu Y, Damle NA, Kumar P, Bal C, Tripathi M, Kandasamy D, Khadgawat R, Agarwal S, Vuthaluru S, Chumber S. Comparison of Neck Ultrasonography, Dual Phase 99mTc-Sestamibi with early SPECT-CT & 18F-Fluorocholine PET-CT as First Line Imaging in Patients with Primary Hyperparathyroidism. Indian J Nucl Med 2023; 38:208-217. [PMID: 38046978 PMCID: PMC10693368 DOI: 10.4103/ijnm.ijnm_28_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 12/05/2023] Open
Abstract
Introduction Successful surgical treatment for primary hyperparathyroidism requires accurate localization of abnormal parathyroid tissue in terms of location and number. Imaging is important for localizing the parathyroid adenoma, and there has been significant interest in 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) for this purpose. Aim This study attempted to ascertain the utility of 18F-FCH PET/CT as a first-line investigation in preoperative localization of abnormal parathyroid tissue in primary hyperparathyroidism, in comparison with 99mTc-sestamibi dual-phase scintigraphy with early single-photon emission computed tomography (SPECT)/CT and neck ultrasonography. Materials and Methods Fifty-five patients with biochemical features of primary hyperparathyroidism were enrolled in this study. They underwent neck ultrasonography, 99mTc-sestamibi dual-phase scintigraphy with early SPECT/CT, and 18F-FCH PET/CT for localization of parathyroid lesions. Thirty-three patients underwent surgical resection of the detected lesions. For two patients, clinical and biochemical follow-up was used as a gold standard. Results A total of 40 lesions were resected in the 33 patients who underwent surgery. A further two lesions were localized in two patients with clinical and biochemical follow-up as the gold standard. Of these 42 lesions, 41 were detected in preoperative imaging and 1 lesion was noted intraoperatively and resected. 41/42 lesions were detected by 18F-FCH PET/CT (detection rate: 97.6%), 33/42 by 99mTc-sestamibi dual-phase scintigraphy with early SPECT/CT (detection rate: 78.5%), and 30/42 by neck ultrasonography (detection rate: 71.4%). Conclusion Detection rates on 18F-FCH PET/CT were superior to both 99mTc-sestamibi dual-phase scintigraphy with early SPECT/CT and neck ultrasonography in preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism.
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Affiliation(s)
- Behera Abhishek
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ritwik Wakankar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yamini Dharmashaktu
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Praveen Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chandrasekhar Bal
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Madhavi Tripathi
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rajesh Khadgawat
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Seenu Vuthaluru
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Chumber
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
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15
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Seyedinia SS, Mirshahvalad SA, Schweighofer-Zwink G, Hehenwarter L, Rendl G, Pirich C, Beheshti M. Evolving Role of [ 18F]Flurocholine PET/CT in Assessing Primary Hyperparathyroidism: Can It Be Considered the First-Line Functional Imaging Approach? J Clin Med 2023; 12:jcm12030812. [PMID: 36769460 PMCID: PMC9917644 DOI: 10.3390/jcm12030812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The accurate detection of hyperfunctioning parathyroid tissue (HFPT) is pivotal in the preoperative assessment of primary hyperparathyroidism (PHPT). PET/CT using [18F]fluorocholine ([18F]FCH) showed superior diagnostic performance compared to conventional functional imaging modalities. We aimed to evaluate the diagnostic performance of [18F]FCH PET/CT as a first-line functional imaging approach in patients with clinically diagnosed PHPT. The imaging and clinical data of 321 PHPT patients, including 271 overt PHPT and 50 mild PHPT, who underwent [18F]FCH PET/CT as first-line imaging were analysed in this retrospective study. Histopathology was the reference standard. In case of no available histopathology evaluation (conservative management), imaging and clinical follow-ups were considered reference standards. In the overt group (n = 271), [18F]FCH PET/CT showed sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 0.99, 0.91, 1.00, 0.80, and 0.99, respectively. Regarding the correlation of the index lesions and initial laboratory data, all [18F]FCH PET/CT parameters (SUVs, SULs, and mSAD) were significantly correlated with the serum iPTH level. Additionally, SUVmax, SULpeak, and mSAD were significantly associated with the serum calcium level. In the mild group (n = 50), [18F]FCH PET/CT showed a sensitivity, specificity, PPV, NPV, and accuracy of 0.93, 0.75, 0.95, 0.67, and 0.90. In conclusion, [18F]FCH PET/CT revealed high diagnostic performance in the detection of HFPTs and the potential to be considered as a first-line imaging modality in the assessment of PHPT, including both overt and mild types. However, its cost-benefit concerning the clinical impact of early PHPT detection should be investigated in future studies.
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Affiliation(s)
- Seyedeh Sara Seyedinia
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON M5G 2M2, Canada
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Hehenwarter
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging & Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: ; Tel.: +43-(0)5-7255-26602
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16
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Nappi C, Piscopo L, Klain M, Mainolfi CG, Vergara E, Adamo D, Mignogna MD, Cuocolo A. Hyperfunctioning parathyroid gland and skeletal involvement on [ 18F]fluorocholine PET/CT: one look with two views. Eur J Hybrid Imaging 2022; 6:28. [PMID: 36504377 PMCID: PMC9742067 DOI: 10.1186/s41824-022-00149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/15/2022] [Indexed: 12/14/2022] Open
Abstract
Hyperparathyroidism is an endocrine disorder that may be associated with other metabolic diseases. Non-invasive imaging techniques including [99mTc]Tc-sestamibi single-photon emission computed tomography (SPECT) and [18F]fluorocholine positron emission tomography (PET)/computed tomography (CT) play a key role on management of patients with hyperparathyroidism. We report for the first time a case of a patient with evidence of both hyperfunctioning parathyroid tissue and multiple lytic bone lesions on [18F]fluorocholine PET/CT imaging. The present case report highlights the potential role of whole-body [18F]fluorocholine PET/CT for the identification of both parathyroid adenoma and multiple bone lesions in a single diagnostic setting.
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Affiliation(s)
- Carmela Nappi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Leandra Piscopo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Michele Klain
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Emilia Vergara
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
| | - Daniela Adamo
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Italy
| | - Michele Davide Mignogna
- grid.4691.a0000 0001 0790 385XDepartment of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Napoli, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University of Naples Federico II, Napoli, Italy
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Jarabek L, Jamsek J, Cuderman A, Rep S, Hocevar M, Kocjan T, Jensterle M, Spiclin Z, Macek Lezaic Z, Cvetko F, Lezaic L. Detection and localization of hyperfunctioning parathyroid glands on [ 18F]fluorocholine PET/ CT using deep learning - model performance and comparison to human experts. Radiol Oncol 2022; 56:440-452. [PMID: 36503715 PMCID: PMC9784363 DOI: 10.2478/raon-2022-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the setting of primary hyperparathyroidism (PHPT), [18F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT. PATIENTS AND METHODS We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model's decision process. RESULTS The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p < 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model's decision process, had correctly identified the foreground PET signal. CONCLUSIONS Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research.
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Affiliation(s)
- Leon Jarabek
- Department of Radiology, General Hospital Novo Mesto, Novo MestoSlovenia
| | - Jan Jamsek
- Department for Nuclear Medicine, University Medical CentreLjubljana, Slovenia
| | - Anka Cuderman
- Department for Nuclear Medicine, University Medical CentreLjubljana, Slovenia
| | - Sebastijan Rep
- Department for Nuclear Medicine, University Medical CentreLjubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Marko Hocevar
- Department of Surgical Oncology, Institute of Oncology, LjubljanaSlovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tomaz Kocjan
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Endocrinology, Diabetes and Metabolic Diseases, University Medical CentreLjubljana, Slovenia
| | - Mojca Jensterle
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department for Endocrinology, Diabetes and Metabolic Diseases, University Medical CentreLjubljana, Slovenia
| | - Ziga Spiclin
- Faculty of Electrical Engineering, University of Ljubljana, LjubljanaSlovenia
| | | | - Filip Cvetko
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Luka Lezaic
- Department for Nuclear Medicine, University Medical CentreLjubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Park HS, Hong N, Jeong JJ, Yun M, Rhee Y. Update on Preoperative Parathyroid Localization in Primary Hyperparathyroidism. Endocrinol Metab (Seoul) 2022; 37:744-755. [PMID: 36327985 PMCID: PMC9633222 DOI: 10.3803/enm.2022.1589] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/04/2022] [Indexed: 12/30/2022] Open
Abstract
Parathyroidectomy is the treatment of choice for primary hyperparathyroidism when the clinical criteria are met. Although bilateral neck exploration is traditionally the standard method for surgery, minimally invasive parathyroidectomy (MIP), or focused parathyroidectomy, has been widely accepted with comparable curative outcomes. For successful MIP, accurate preoperative localization of parathyroid lesions is essential. However, no consensus exists on the optimal approach for localization. Currently, ultrasonography and technetium-99m-sestamibi-single photon emission computed tomography/computed tomography are widely accepted in most cases. However, exact localization cannot always be achieved, especially in cases with multiglandular disease, ectopic glands, recurrent disease, and normocalcemic primary hyperparathyroidism. Therefore, new modalities for preoperative localization have been developed and evaluated. Positron emission tomography/computed tomography and parathyroid venous sampling have demonstrated improvements in sensitivity and accuracy. Both anatomical and functional information can be obtained by combining these methods. As each approach has its advantages and disadvantages, the localization study should be deliberately chosen based on each patient's clinical profile, costs, radiation exposure, and the availability of experienced experts. In this review, we summarize various methods for the localization of hyperfunctioning parathyroid tissues in primary hyperparathyroidism.
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Affiliation(s)
- Hye-Sun Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Thyroid Cancer Clinic, Seoul, Korea
| | - Mijin Yun
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Corresponding author: Yumie Rhee. Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1973, Fax: +82-2-393-6884, E-mail:
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Jacquet-Francillon N, Morelec I, Germain N, Prades JM, Habouzit V, Mariat C, Bonnefoy PB, Prevot N. Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study). Front Med (Lausanne) 2022; 9:956580. [PMID: 35983092 PMCID: PMC9380568 DOI: 10.3389/fmed.2022.956580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective [18F]Fluorocholine positron emission tomography/computed tomography (PET/CT) is used frequently in addition to [99mTc]Tc-Sestamibi scintigraphy and ultrasonography for the location of hyperfunctioning parathyroid glands. The aim of this study is to evaluate the performance of quantitative criteria in [18F]fluorocholine PET/CT for localization of hyperfunctioning parathyroid glands. The secondary objective is to highlight a correlation between the detection rate of [18F]fluorocholine PET/CT and serum parathyroid hormone (PTH) level. Materials and methods In two academic centers, we retrospectively included patients with biological hyperparathyroidism (HPT) and who had [18F]fluorocholine PET/CT. After a visual analysis, to measure the overall performance of [18F]fluorocholine PET/CT, a blind reading was carried out with standardized measurements of maximum standardized uptake value (SUVmax), liver ratio, thyroid ratio, and size ratio. We analyzed the quantitative criteria of [18F]fluorocholine PET/CT compared to the histological results, in particular to identify differences between adenomas and hyperplasias. We compared the performance of each quantitative criterion to the overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [18F]fluorocholine PET/CT. The detection rate of hyperfunctioning parathyroid glands was calculated in subgroups of serum PTH level. Results The quantitative criteria in [18F]fluorocholine PET/CT were measured for 120 patients (135 lesions). The areas under the receiver operating characteristic (ROC) curve representing SUVmax and liver ratio were significantly increased. The optimal cut-off values represented by the maximum Youden index was >4.12 for SUVmax and >27.4 for liver ratio. Beyond certain threshold values of SUVmax (>4.12) or liver ratio (>38.1), all the lesions were histologically proven adenomas. SUVmax and liver ratio were significantly higher for adenomas than for hyperplasias and differential diagnosis (p = 0.0085 and p = 0.0002). The positivity of [18F]fluorocholine PET/CT was correlated with PTH level. Detection rates were 55.56, 75.56, and 87.5%, respectively, for serum PTH < 70, 70 to 120, and >120 ng/ml. Conclusion Semi-quantitative measurements (SUVmax and liver ratio) should be considered as additional tools in interpretation of [18F]fluorocholine PET/CT. These quantitative parameters have lower overall performance but higher specificity than overall visual analysis in identifying an adenoma. Above certain threshold values, all lesions are adenomas. [18F]fluorocholine PET/CT confirms excellent performance for the detection of hyperfunctional parathyroids. For serum PTH levels < 70 ng/ml, the detection rate of [18F]fluorocholine PET/CT is strongly decreased.
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Affiliation(s)
- Nicolas Jacquet-Francillon
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
- *Correspondence: Nicolas Jacquet-Francillon,
| | - Isabelle Morelec
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Natacha Germain
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, Centre Hospitalo-Universitaire (CHU) de Saint-Étienne, Saint-Étienne, France
- Eating Disorders, Addictions and Extreme Bodyweight Research Group (TAPE) EA 7423, Université Jean Monnet, Saint-Étienne, France
| | - Jean-Michel Prades
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Saint-Étienne, Saint-Étienne, France
- Laboratory of Human Anatomy, Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France
| | - Vincent Habouzit
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
| | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal Transplantation, Hôpital Nord, Centre Hospitalo-Universitaire (CHU) de Saint-Étienne, Jean Monnet University, Université de Lyon, Saint-Étienne, France
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP, EA 3065, University of Jean Monnet and Université de Lyon, Saint-Étienne, France
| | - Pierre-Benoit Bonnefoy
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
| | - Nathalie Prevot
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, Univ Lyon, Univ Saint-Etienne, Saint-Etienne, France
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20
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Jang H, Lee S, Kim D, Hong N. Retropharyngeal Ectopic Parathyroid Adenoma Localized by 18F-Fluorocholine Positron Emission Tomography/Computed Tomography: A Case Report. J Bone Metab 2022; 29:197-203. [PMID: 36153856 PMCID: PMC9511128 DOI: 10.11005/jbm.2022.29.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/22/2022] [Indexed: 11/11/2022] Open
Abstract
Ectopic parathyroid adenomas of the retropharyngeal space are relatively rare. Herein, we report a case of primary hyperparathyroidism (PHPT) secondary to a retropharyngeal parathyroid adenoma. A 22-year-old woman presented with elevated serum calcium and parathyroid hormone (PTH) levels, revealed during a medical check-up. The patient had a history of ureteral stones and a confirmed low bone mass. Neck 99mTechnetium-sestamibi singlephoton emission computed tomography (CT) and ultrasonography did not reveal any suspicious lesions. There was no evidence of hereditary PHPT based on the results of targeted gene sequencing. Surgical exploration was unsuccessful, and the PHPT persisted after the first surgery. Approximately a year after the failed operation, 18F-fluorocholine (FCH) positron emission tomography/CT (PET-CT) became available, and when performed, it revealed increased uptake in the retropharyngeal space of the right side of the neck. The results of parathyroid venous sampling were concordant with a >2-fold elevation of PTH level in the veins on the right side of the neck compared to the peripheral veins. The 1.8 cm-diameter mass was successfully removed resulting in an 87% reduction in intraoperative PTH level (198.0–26.5 pg/mL). Subsequently, normalizations of calcium and PTH levels were achieved. In summary, ectopic parathyroid adenomas, including retropharyngeal lesions, should also be suspected when investigating an elusive case of PHPT. 18F-FCH PET-CT can be a useful complementary modality for detecting culprit lesions.
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Affiliation(s)
| | - Seunghyun Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dahee Kim
- Department of Otorhinolaryngology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namki Hong
- Division of Endocrinology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Adnan A, Raju S, Kumar R, Basu S. An Appraisal and Update of Fluorodeoxyglucose and Non-Fluorodeoxyglucose-PET Tracers in Thyroid and Non-Thyroid Endocrine Neoplasms. PET Clin 2022; 17:343-367. [PMID: 35717097 DOI: 10.1016/j.cpet.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Endocrine neoplasms and malignancies are a diverse group of tumors with varied clinical, histopathologic, and functional features. These tumors vary from sporadic to hereditary, isolated entities to multiple neoplastic syndromes, functioning and non functioning tumors, unifocal locally invasive, and advanced to multifocal tumors with disseminated distant metastases. The presence of various specific biomarkers and specific receptor targets serves as valuable tools for diagnosis, prognosis, and management. PET-CT with FDG and a multitude of novel and specific radiotracers towards specific therapeutic targets mandates personalization of their use, so as to ensure maximum clinical benefit in the management of these neoplasms.
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Affiliation(s)
- Aadil Adnan
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Parel, Mumbai, India; Homi Bhabha National Institute, Mumbai, India
| | - Shobhana Raju
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sandip Basu
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Parel, Mumbai, India; Homi Bhabha National Institute, Mumbai, India.
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22
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Talbot JN, Zhang-Yin J, Kerrou K, Aveline C, Vagne B, Bélissant O, Tassart M, Périé S, Bouchard P, Christin-Maitre S, Ménégaux F, Groussin L, Gaujoux S, Balogová S, Montravers F. Multiple endocrine neoplasia type 1 or 4: detection of hyperfunctioning parathyroid glands with 18F-fluorocholine PET/CT. Illustrative cases and pitfalls. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:130-140. [PMID: 35005879 DOI: 10.23736/s1824-4785.22.03440-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
18F-fluorocholine (FCH) PET/CT is now well established to detect the hyperfunctioning parathyroid glands (HFPTG) in a case of sporadic primary hyperparathyroidism (pHPT), but only limited evidence is available about the utility of FCH PET/CT to detect the HFPTG in patients with multiple endocrine neoplasia (MEN) type 1 or 4. The pHPT in this context frequently consists in a multiglandular disease with small hyperplastic glands rather than adenomas, which is challenging for imaging modalities. The data of patients with MEN1 or MEN4 after parathyroidectomy referred to FCH PET/CT for presurgical localization of HFPTG were retrospectively reviewed, including follow-up after parathyroidectomy, in search for diagnostic performance and for potential pitfalls. In the present cohort, 16 patients referred to FCH PET/CT as part of their initial pHPT work-up were subsequently operated, 44 abnormal parathyroid glands (PT) were resected, of which 32 (73%) had been detected on FCH PET/CT and 2 considered as equivocal foci. Nine patients referred to FCH PET/CT for recurrent pHPT who were subsequently operated, 14 abnormal PT were resected, all had been detected on FCH PET/CT. FCH PET/CT permitted a unilateral approach for PTx in 4 of them. In one patient with MEN4 and pHPT, the HFPTG could not be visualized on FCH PET/CT but was localized by ultrasonography. Several causes of false positive or false negative results, incidental finding and pitfalls are listed and discussed. FCH PET/CT has a positive benefit/risk ratio in the detection of HFPTG in case of MEN1 (the data in MEN4 being currently very limited) with the most effective detection rate of current imaging modalities for HFPTG, few pitfalls, and an adequate impact on patient management compared to sesta MIBI SPECT and ultrasonography.
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Affiliation(s)
- Jean-Noël Talbot
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Jules Zhang-Yin
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Khadoun Kerrou
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Cyrielle Aveline
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Benedicte Vagne
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Ophélie Bélissant
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Marc Tassart
- Department of Radiology, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Sophie Périé
- Department of Head and Neck Surgery, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
| | - Phillipe Bouchard
- Department of Endocrinology, Hôpital Saint-Antoine AP-HP, Sorbonne University, Paris, France
| | - Sophie Christin-Maitre
- Department of Endocrinology, Hôpital Saint-Antoine AP-HP, Sorbonne University, Paris, France
| | - Fabrice Ménégaux
- Department of Surgery, Pitié-Salpétrière University Hospital, Sorbonne University, Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin AP-HP, University of Paris, Paris, France
| | - Sébastien Gaujoux
- Department of Pancreatic and Endocrine Surgery, Hôpital Cochin AP-HP, University of Paris, Paris, France
| | - Soňa Balogová
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France -
- Department of Nuclear Medicine, St. Elisabeth Oncology Institute, Comenius University, Bratislava, Slovakia
| | - Françoise Montravers
- Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France
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Gass JM, Wicke C, Mona C, Strobel K, Müller W, Metzger J, Suter-Widmer I, Henzen C, Fischli S. 18F-Fluorocholine-PET combined with contrast-enhanced CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism. Endocrine 2022; 75:593-600. [PMID: 34561784 DOI: 10.1007/s12020-021-02877-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/12/2021] [Indexed: 12/20/2022]
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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Affiliation(s)
- Jörn-Markus Gass
- Division of Visceral Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Corinna Wicke
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Caroline Mona
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Klaus Strobel
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Division of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Werner Müller
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Division of Otorhinolaryngology and Head and Neck Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Jürg Metzger
- Division of Visceral Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Isabelle Suter-Widmer
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Christoph Henzen
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland
| | - Stefan Fischli
- Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
- Division of Endocrinology, Diabetes and Clinical Nutrition, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
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Positron nuclear medicine imaging: Parathyroid diseases. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Dudoignon D, Delbot T, Cottereau AS, Dechmi A, Bienvenu M, Koumakis E, Cormier C, Gaujoux S, Groussin L, Cochand-Priollet B, Clerc J, Wartski M. 18F-fluorocholine PET/CT and conventional imaging in primary hyperparathyroidism. Diagn Interv Imaging 2022; 103:258-265. [DOI: 10.1016/j.diii.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 11/03/2022]
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Araz M, Nak D, Soydal Ç, Peker E, Erden İ, Küçük NÖ. Detectability of 18F-choline PET/MR in primary hyperparathyroidism. Eur Arch Otorhinolaryngol 2021; 279:2583-2589. [PMID: 34495350 DOI: 10.1007/s00405-021-07046-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/15/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE We aimed to evaluate the power of 18F-fluorocholine (FCH) positron emission tomography/magnetic resonance (PET/MR) imaging in unlocalized primary hyperparathyroidism. METHODS Thirty-four patients were included. In 17/34 patients, PET/MR was performed immediately after a negative 18F-FCH PET/CT. Sensitivity, specificity, positive and negative predictive values were calculated for MR only (blinded to PET data) and PET only (blinded to MR data) findings. RESULTS 18F-FCH PET/MR was positive in 26/34 (76%) patients. PET/MR was also positive in 12/17 (71%) patients with a negative PET/CT. Among 11/34 (32%) patients where 18F-FCH PET-only and MR-only results were discordant, MR was false positive in 7/11 patients (3/7 of the lesions were not 18F-FCH avid and in 4/7 of them PET and MRI pointed different locations. Postoperative histopathology revealed that 18F-FCH-positive ones were true positives). Sensitivity, specificity, PPV, NPV and accuracy of neck MR evaluated blinded to PET data were 80%, 50%, 70%, 64% and 68%, respectively, and all were calculated as 100% for PET/MR. CONCLUSION 18F-FCH PET/MR is very effective in preoperative localization of parathyroid adenomas even if 18F-FCH PET/CT is negative. Neck MR alone is insufficient in detecting parathyroid adenomas but PET/MR combination helps in precise localisation.
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Affiliation(s)
- Mine Araz
- Nuclear Medicine Department, Cebeci Hospital, Ankara University Medical Faculty, Ankara, Turkey.
| | - Demet Nak
- Nuclear Medicine Department, Cebeci Hospital, Ankara University Medical Faculty, Ankara, Turkey
| | - Çiğdem Soydal
- Nuclear Medicine Department, Cebeci Hospital, Ankara University Medical Faculty, Ankara, Turkey
| | - Elif Peker
- Radiology Department, Ankara University Medical School, Ankara, Turkey
| | - İlhan Erden
- Radiology Department, Ankara University Medical School, Ankara, Turkey
| | - N Özlem Küçük
- Nuclear Medicine Department, Cebeci Hospital, Ankara University Medical Faculty, Ankara, Turkey
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Whitman J, Allen IE, Bergsland EK, Suh I, Hope TA. Assessment and Comparison of 18F-Fluorocholine PET and 99mTc-Sestamibi Scans in Identifying Parathyroid Adenomas: A Metaanalysis. J Nucl Med 2021; 62:1285-1291. [PMID: 33452040 PMCID: PMC8882892 DOI: 10.2967/jnumed.120.257303] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/03/2021] [Indexed: 01/24/2023] Open
Abstract
Hyperparathyroidism is an endocrine disorder caused by one or more hyperfunctioning parathyroid glands. Current imaging consisting of ultrasound and 99mTc-sestamibi is imprecise, making localization difficult. 18F-fluorocholine (18F-FCH) PET has recently shown promise in presurgical localization of parathyroid adenomas. The primary aim of this study was to summarize the sensitivities and specificities of studies using 18F-FCH PET to localize hyperparathyroidism. A secondary aim was to summarize a subset of studies in which 99mTc-sestamibi scans were also used and to compare the performance of the 2 modalities. Methods: We searched the MEDLINE and EMBASE databases following the PRISMA (Preferred Reporting Items for Systematic Review and Metaanalysis) statement. Quality was assessed using the QUADAS-2 tool (Quality Assessment of Diagnostic Accuracy Studies). Twenty studies were included for quantitative assessment in our metaanalysis. A random-effects model and a hierarchic summary receiver-operating-characteristic model was used to summarize the sensitivity of 18F-FCH PET in detecting abnormal parathyroid adenomas. We used the same methodology to assess sensitivity of 99mTc-sestamibi, as a comparison to 18F-FCH PET. Results:18F-FCH PET had a high sensitivity, 0.97 (range, 0.96-0.98), for the detection of abnormal parathyroid adenomas. In the subpopulation for which both 18F-FCH and 99mTc-sestamibi were reported, 18F-FCH also had a higher sensitivity, 0.96 (0.94-0.98), than the 0.54 (0.29-0.79) reported for 99mTc-sestamibi (P < 0.001). Conclusion:18F-FCH PET demonstrates high localization accuracy in patients with hyperparathyroidism. This metaanalysis supports the use of 18F-FCH over 99mTc-sestamibi in patients with hyperparathyroidism.
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Affiliation(s)
- Julia Whitman
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Isabel E Allen
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Emily K Bergsland
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Insoo Suh
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Thomas A Hope
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California;
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California; and
- Department of Radiology, San Francisco VA Medical Center, San Francisco, California
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Acuña Hernandez M, Sanchez Orduz L, Cancino Ramos U, Vallejo Armenta P, Cadavid Blanco L. Is there a consensus between clinical practice guidelines for conventional and molecular nuclear medicine studies in parathyroid pathology? Ann Nucl Med 2021; 35:994-1003. [PMID: 34302628 DOI: 10.1007/s12149-021-01658-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2023]
Abstract
Hyperparathyroidism is a common calcium metabolic disorder, characterized by the presence of high concentrations or inappropriately normal concentrations of parathyroid hormone (PTH) in the context of high calcium. Pharmacological and surgical management is available as treatment. The objective of diagnostic imaging is to determine the location of the causal lesion. For these purposes, non-invasive methods can be divided into anatomical or functional studies, with nuclear medicine studies being in the latter category. The objective of this review, is to establish the similarities and differences that exist in the clinical practice guidelines on conventional and molecular nuclear medicine studies in parathyroid disease.
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Affiliation(s)
- Marylin Acuña Hernandez
- Specialist in Nuclear Medicine and Epidemiology, Universidad Autónoma de Bucaramanga (UNAB)-Bogotá Surgery Society-San José Hospital, Bogotá, Colombia.
| | - Liset Sanchez Orduz
- Specialist in Nuclear Medicine, SPECT Medicina Nuclear S.A.S. Bucaramanga, Santander, Colombia
| | - Uvi Cancino Ramos
- Specialist in Nuclear Medicine, Highly Specialized in Nuclear Oncology and Nuclear Neurosciences, Instituo Mexicano del Seguro Social, Centro Medico Nacional Siglo XXI, Hospital de Pediatria, Ciudad de México, México
| | - Paola Vallejo Armenta
- Specialist in Nuclear Medicine-Highly Specialized in Nuclear Oncology, Ciudad de México, México
| | - Leonardo Cadavid Blanco
- Specialist in Nuclear Medicine-Head of the Nuclear Medicine Service, Bogotá Surgery Society-San José Hospital-Fundación de Ciencias Universitarias de la Salud (FUCS), Bogotá, Colombia
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de Jong MC, Jamal K, Morley S, Beale T, Chung T, Jawad S, Hurel S, Simpson H, Srirangalingam U, Baldeweg SE, Rozalén García V, Otero S, Shawky M, Abdel-Aziz TE, Kurzawinski TR. The use of computed tomography as a first-line imaging modality in patients with primary hyperparathyroidism. Hormones (Athens) 2021; 20:499-506. [PMID: 32405929 DOI: 10.1007/s42000-020-00205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The success of minimally invasive parathyroidectomy (MIP) relies on accurate localization of the abnormal parathyroid glands. Concordant findings on ultrasound (US) and 99mTc-scintigraphy (sestamibi) are currently considered the 'gold standard'. Computed tomography (CT) has also recently been used in preoperative planning. We sought to assess the accuracy of CT for localization of abnormal parathyroid glands in such patients. METHODS An audit of 75 patients with primary hyperparathyroidism (PHPT) who underwent neck US and CT between 2017 and 2019 at our center as their first-line imaging. RESULTS All 75 patients underwent US and CT and 54 (72.0%) also had sestamibi. CT alone identified a potential target in all patients, of which the location was correct in 63 (84.0%). The overall combined sensitivity of US and CT was 88% (95% CI 78-94) and was higher than the combined sensitivity of US and sestamibi (65% [95% CI 53-76]; p < 0.001). Twenty-one patients (28.0%) had an ectopic gland, and the sensitivity of US and CT was 86% (95% CI 64-96) versus US and sestamibi (57% [95% CI 34-77]; p = 0.016). For adenomas < 1.0 g (n = 36; 48%), the accuracy of CT was 81% (95% CI 64-91) compared with 62% (95% CI 44-77) for US and sestamibi (p = 0.04). The correct preoperative diagnosis of multiglandular disease (n = 9; 12%) seemed to be the most difficult, with similar accuracy for US and sestamibi (40% [95% CI 14-73]) and US and CT (50% [95% CI 20-80]) (p > 0.99). CONCLUSION The combination of US and CT was able to correctly identify the location of the abnormal parathyroid in 88% of patients and, in comparison with US and sestamibi, had better diagnostic accuracy, especially for smaller and ectopic adenomas. This finding suggests that US and CT could be considered as a first-line imaging modality in patients with PHPT considered for MIP.
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Affiliation(s)
- Mechteld C de Jong
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK.
| | - K Jamal
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Morley
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T Beale
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T Chung
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Jawad
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Hurel
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - H Simpson
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - U Srirangalingam
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S E Baldeweg
- Department of Endocrinology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - V Rozalén García
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - S Otero
- Department of Radiology, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - M Shawky
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T E Abdel-Aziz
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
| | - T R Kurzawinski
- Centre for Endocrine Surgery, University College London Hospital, 235 Euston Road, London, NW1 2BU, UK
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Petranović Ovčariček P, Giovanella L, Carrió Gasset I, Hindié E, Huellner MW, Luster M, Piccardo A, Weber T, Talbot JN, Verburg FA. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging 2021; 48:2801-2822. [PMID: 33839893 PMCID: PMC8263421 DOI: 10.1007/s00259-021-05334-y] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/23/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration. METHODS Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT. CONCLUSION These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.
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Affiliation(s)
- Petra Petranović Ovčariček
- EANM Thyroid Committee, Vienna, Austria
- Department of Oncology and Nuclear medicine, University Hospital Center "Sestre milosrdnice", Zagreb, Croatia
| | - Luca Giovanella
- EANM Thyroid Committee, Vienna, Austria
- Clinic for Nuclear Medicine and Competence Centre for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
- Clinic for Nuclear Medicine and Interdisciplinary Thyroid Centre, University Hospital and University of Zurich, Zurich, Switzerland
| | - Ignasi Carrió Gasset
- Department of Nuclear Medicine, Hospital Sant Pau and Autonomous University of Barcelona, Barcelona, Spain
| | - Elif Hindié
- Department of Nuclear Medicine, Bordeaux Hospital and University, Bordeaux, France
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| | - Markus Luster
- EANM Thyroid Committee, Vienna, Austria
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Genoa, Italy
| | - Theresia Weber
- Department of Endocrine Surgery, Katholisches Klinikum Mainz, Mainz, Germany
| | - Jean-Noël Talbot
- Nuclear Medicine, Hospital Tenon APHP and Sorbonne University, Paris, France
| | - Frederik Anton Verburg
- EANM Thyroid Committee, Vienna, Austria.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
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Smaxwil C, Aschoff P, Reischl G, Busch M, Wagner J, Altmeier J, Ploner O, Zielke A. [ 18F]fluoro-ethylcholine-PET Plus 4D-CT (FEC-PET-CT): A Break-Through Tool to Localize the "Negative" Parathyroid Adenoma. One Year Follow Up Results Involving 170 Patients. J Clin Med 2021; 10:jcm10081648. [PMID: 33924371 PMCID: PMC8068905 DOI: 10.3390/jcm10081648] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 03/16/2021] [Accepted: 03/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background: The diagnostic performance of [18F]fluoro-ethylcholine-PET-CT&4D-CT (FEC-PET&4D-CT) to identify parathyroid adenomas (PA) was analyzed when ultrasound (US) or MIBI-Scan (MS) failed to localize. Postsurgical one year follow-up data are presented. Methods: Patients in whom US and MS delivered either incongruent or entirely negative findings were subjected to FEC-PET&4D-CT and cases from July 2017 to June 2020 were analyzed, retrospectively. Cervical exploration with intraoperative PTH-monitoring (IO-PTH) was performed. Imaging results were correlated to intraoperative findings, and short term and one year postoperative follow-up data. Results: From July 2017 to June 2020 in 171 FEC-PET&4D-CTs 159 (92.9%) PAs were suggested. 147 patients already had surgery, FEC-PET&4D-CT accurately localized in 141; false neg. 4, false pos. 2, global sensitivity 0.97; accuracy 0.96, PPV 0.99. All of the 117 patients that already have completed their 12-month postoperative follow up had normal biochemical parameter, i.e., no signs of persisting disease. However, two cases may have a potential for recurrent disease, for a cure rate of at least 98.3%. Conclusion: FEC-PET&4D-CT shows unprecedented results regarding the accuracy localizing PAs. The one-year-follow-up data demonstrate a high cure rate. We, therefore, suggest FEC-PET-CT as the relevant diagnostic tool for the localization of PAs when US fails to localize PA, especially after previous surgery to the neck.
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Affiliation(s)
- Constantin Smaxwil
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
- Correspondence: ; Tel.: +49-711-9913301; Fax: +49-711-9913309
| | - Philip Aschoff
- Department of Nuclear Medicine and PET-CT Centre, Institute of Diagnostic and Interventional Radiology, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Gerald Reischl
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany;
- Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University of Tuebingen, 72076 Tuebingen, Germany
| | - Mirjam Busch
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
| | - Joachim Wagner
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
| | - Julia Altmeier
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
| | - Oswald Ploner
- Department of Internal Medicine, Endocrinology, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Andreas Zielke
- Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (M.B.); (J.W.); (J.A.); (A.Z.)
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Noltes ME, Kruijff S, Jansen L, Westerlaan HE, Zandee WT, Dierckx RAJO, Brouwers AH. A retrospective analysis of the diagnostic performance of 11C-choline PET/CT for detection of hyperfunctioning parathyroid glands after prior negative or discordant imaging in primary hyperparathyroidism. EJNMMI Res 2021; 11:32. [PMID: 33770255 PMCID: PMC7997941 DOI: 10.1186/s13550-021-00778-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 03/22/2021] [Indexed: 12/19/2022] Open
Abstract
Background Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a next in-line scan after primary negative or discordant first-line imaging. Methods This was a retrospective single-center cohort study. All patients with pHPT that were scanned utilizing 11C-choline PET/CT, after prior negative or discordant imaging, between 2015 and 2019 and who subsequently underwent parathyroid surgery were included. The results of the 11C-choline PET/CT were evaluated lesion-based, with surgical exploration and histopathological examination as the gold standard. Results In total, 36 patients were included of which three patients were known to have Multiple Endocrine Neoplasia (MEN) syndrome. In these 36 patients, 40 lesions were identified on 11C-choline PET/CT and 37 parathyroid lesions were surgically removed. In 34/36 (94%) patients a focused parathyroidectomy was performed, in one patient a cervical exploration due to an ectopically identified adenoma, and in one patient a bilateral exploration was performed because of a double adenoma. Overall, per-lesion sensitivity of 11C-choline PET/CT was 97%, the positive predictive value was 95% and the accuracy was 94% for all parathyroid lesions. Conclusions In patients with pHPT and prior negative or discordant first-line imaging results, pathological parathyroid glands can be localized by 11C-choline PET/CT with high sensitivity and accuracy.
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Affiliation(s)
- M E Noltes
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - S Kruijff
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.,Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - L Jansen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H E Westerlaan
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W T Zandee
- Department of Internal Medicine, Division of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - A H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
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Ferrari C, Santo G, Mammucci P, Pisani AR, Sardaro A, Rubini G. Diagnostic Value of Choline PET in the Preoperative Localization of Hyperfunctioning Parathyroid Gland(s): A Comprehensive Overview. Biomedicines 2021; 9:biomedicines9030231. [PMID: 33669104 PMCID: PMC7996619 DOI: 10.3390/biomedicines9030231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 12/03/2022] Open
Abstract
Hyperparathyroidism is a metabolic disorder characterized by the excessive production of the parathyroid hormone. The diagnosis is based on clinical and laboratory data. In most cases the only treatment is surgery and a correct preoperatory localization of the hyperfunctioning parathyroid gland(s) is essential. Currently, ultrasonography combined with [99mTc]Tc-MIBI parathyroid scintigraphy, optionally associated with single photon emission computed tomography/computed tomography (SPECT/CT), represent the standard preoperative imaging. In recent years, a number of studies have evaluated the potential role of choline positron emission tomography (PET) in hyperparathyroidism with promising results. Most of the recent evidence underlined its higher sensitivity and diagnostic accuracy in the localization of hyperfunctioning parathyroid glands. Choline PET has a higher spatial resolution that is useful for the detection of smaller parathyroid glands and it also has shorter examination times and favorable radiation exposure. These are just a few of the aspects that support it to overcome traditional imaging. Moreover, from the preliminary data, the choline uptake mechanism seems to also have an impact on its better performance. For these reasons, if first used as second level imaging in patients with negative or inconclusive traditional imaging results, several authors have supported its use as a first line investigation. This comprehensive overview aims to provide an accurate description of the preliminary results available in the literature about the use of choline PET/CT in hyperparathyroidism and to compare these results with the performance of traditional imaging methods.
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Affiliation(s)
- Cristina Ferrari
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (C.F.); (G.S.); (P.M.); (A.R.P.); (G.R.)
| | - Giulia Santo
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (C.F.); (G.S.); (P.M.); (A.R.P.); (G.R.)
| | - Paolo Mammucci
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (C.F.); (G.S.); (P.M.); (A.R.P.); (G.R.)
| | - Antonio Rosario Pisani
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (C.F.); (G.S.); (P.M.); (A.R.P.); (G.R.)
| | - Angela Sardaro
- Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
| | - Giuseppe Rubini
- Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70124 Bari, Italy; (C.F.); (G.S.); (P.M.); (A.R.P.); (G.R.)
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Mukhtar NN, Abouzied MEDM, Alqahtani MH, Hammami MM. Misleading localization by 18F-fluorocholine PET/CT in familial hypocalciuric hypercalcemia type-3: a case report. BMC Endocr Disord 2021; 21:20. [PMID: 33499837 PMCID: PMC7836468 DOI: 10.1186/s12902-021-00683-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Familial hypocalciuric hypercalcemia (FHH) is a heterogeneous autosomal-dominant disorder of calcium hemostasis that may be difficult to distinguish clinically from mild primary hyperparathyroidism. Loss-of-function mutations mainly involving Arg15 residue of the adaptor-related protein complex 2, sigma subunit 1 (AP2S1) cause a rarer, more recently recognized form of FHH, FFH type-3. Recently, 18F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT) showed superior sensitivity to conventional imaging in localizing parathyroid adenomas. We report a new FFH type-3 patient who underwent unnecessary parathyroidectomy in association with misleading FCH-PET/CT imaging. CASE PRESENTATION A 29-year old woman was initially evaluated for parathyroid hormone (PTH)-dependent hypercalcemia in 2013. Medical history was positive only for chronic constipation and malaise with no personal or family history of hypercalcemia, kidney stones, or neck surgery. Over seven years, serum calcium level was 2.51-2.89 mmol/L with concomitant PTH level of 58.7-94.8 mmol/L. Serum phosphate levels were in the low/low normal range. Serum creatinine and magnesium levels were normal. 25-hydroxy vitamin D level was 13 nmol/L. 24-hour urine calcium level was 1.92 mmol/day but increased to 6.99 mmol/day after treatment with cholecalciferol 1000 IU daily. Bone mineral density and renal ultrasound were normal. Parathyroid ultrasound showed two hypoechoic nodules inferior to the left and right thyroid lobes; however, 99mtechnitium-sestamibi scans (2013, 2016, 2018) were negative. FCH-PET/CT (2019) showed focal uptake co-localizing with the nodule inferior to the left thyroid lobe. The patient underwent left inferior parathyroidectomy and pathology was consistent with parathyroid hyperplasia. However, postoperatively, serum calcium and PTH levels remained elevated and FCH-PET/CT and ultrasound showed persistence of the uptake/nodule. Whole exome sequencing showed Arg15Cys mutation in the AP2S1 gene characteristic of FHH type-3. CONCLUSIONS In this new case of FHH type-3, FCH-PET/CT failed to localize to the hyperplastic parathyroid glands and localized instead to apparently a lymph node. This, together with increased urinary calcium after vitamin D supplementation, led to unnecessary parathyroidectomy. Given the increasingly lower cost of genetic testing and the cost of follow up and unnecessary surgery, it may prudent to include genetic testing for FHH early on in patients with mild PTH-dependent hypercalcemia.
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Affiliation(s)
- Noha N Mukhtar
- Department of Medicine , King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mohammed H Alqahtani
- Department of Cyclotron and Radiopharmaceuticals, Alfaisal University, Riyadh, Saudi Arabia
| | - Muhammad M Hammami
- Department of Medicine , King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Department of Clinical Studies and Empirical Ethics, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), 11211 Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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Cormier C, Koumakis E. Bones and Primary Hyperparathyroidism. Joint Bone Spine 2021; 89:105129. [PMID: 33484857 DOI: 10.1016/j.jbspin.2021.105129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 10/22/2022]
Abstract
Primary hyperparathyroidism (PHPT) is a disease caused by excessive and inappropriate secretion of parathyroid hormone resulting in hypercalcemia. It is usually diagnosed incidentally in the face of hypercalcemia, a complication such as osteoporosis or, more rarely, a renal complication with lithiasis. The clinical presentation reflects hypercalcemia and involves several organs, mainly the cardiovascular system, bones, and kidneys. However, most patients with PHPT are asymptomatic. The diagnosis is made based on laboratory tests. It is easy when serum calcium and parathyroid hormone levels are high, but difficult when one of these two values is normal. Normocalcemic PHPT can be diagnosed only after ruling out all causes of secondary hyperparathyroidism. Parathyroid imaging cannot diagnose it but guides the surgeon and rules out an associated thyroid abnormality. The reference treatment is surgery. The surgical indication is based on the presence or risk of complications, and it is the only treatment that prevents fractures. Pharmaceutical treatments have only limited effects on complications and are reserved for cases where surgery is contraindicated. After parathyroid surgery, the use of bisphosphonates must be avoided as they seem to interfere with the parathyroidectomy's fracture-preventing effects. If surgery is not indicated, a plan for monitoring laboratory values, bone density, and renal function will be established.
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Affiliation(s)
- Catherine Cormier
- Service de Rhumatologie Hôpital Cochin, APHP, Université Paris Descartes Centre de Référence des Maladies du Métabolisme du Calcium et du Phosphate 27 Rue du Faubourg St Jacques, 75679 PARIS Cedex 14, France.
| | - Eugénie Koumakis
- Service de Rhumatologie Hôpital Cochin, APHP, Université Paris Descartes Centre de Référence des Maladies du Métabolisme du Calcium et du Phosphate 27 Rue du Faubourg St Jacques, 75679 PARIS Cedex 14, France
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Quak E, Lasne Cardon A, Ciappuccini R, Lasnon C, Bastit V, Le Henaff V, Lireux B, Foucras G, Jaudet C, Berchi C, Grellard JM, Lequesne J, Clarisse B, Bardet S. Upfront F18-choline PET/CT versus Tc99m-sestaMIBI SPECT/CT guided surgery in primary hyperparathyroidism: the randomized phase III diagnostic trial APACH2. BMC Endocr Disord 2021; 21:3. [PMID: 33413316 PMCID: PMC7791717 DOI: 10.1186/s12902-020-00667-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The common endocrine disorder primary hyperparathyroidism (PHPT) can be cured by surgery. Preoperative localization of parathyroid adenoma (PTA) by imaging is a prerequisite for outpatient minimally invasive parathyroidectomy (MIP). Compared to inpatient bilateral cervical exploration (BCE) which is performed if imaging is inconclusive, MIP is superior in terms of cure and complication rates and less costly. The imaging procedure F18-choline (FCH) PET/CT outperforms Tc99m-sestaMIBI (MIBI) SPECT/CT for PTA localization, but it is much costlier. The aim of this study is to identify the most efficient first-line imaging modality for optimal patient care in PHPT without added cost to society. METHODS We will conduct a multicenter open diagnostic intervention randomized phase III trial comparing two diagnostic strategies in patients with PHPT: upfront FCH PET/CT versus MIBI SPECT/CT. The primary endpoint is the proportion of patients in whom the first-line imaging method results in successful MIP and cure. Follow-up including biological tests will be performed 1 and 6 months after surgery. The main secondary endpoint is the social cost of both strategies. Other secondary endpoints are as follows: FCH PET/CT and MIBI SPECT/CT diagnostic performance, performance of surgical procedure and complication rate, FCH PET/CT inter- and intra-observer variability and optimization of FCH PET/CT procedure. Fifty-eight patients will be enrolled and randomized 1:1. DISCUSSION FCH PET/CT is a highly efficient but expensive imaging test for preoperative PTA localization and costs three to four times more than MIBI SPECT/CT. Whether FCH PET/CT improves patient outcomes compared to the reference standard MIBI SPECT/CT is unknown. To justify its added cost, FCH PET/CT-guided parathyroid surgery should lead to improved patient management, resulting in higher cure rates and fewer BCEs and surgical complications. In the previous phase II APACH1 study, we showed that second-line FCH PET/CT led to a cure in 88% of patients with negative or inconclusive MIBI SPECT/CT. BCE could be avoided in 75% of patients and surgical complication rates were low. We therefore hypothesize that upfront FCH PET/CT would improve patient care in PHPT and that the reduction in clinical costs would offset the increase in imaging costs. TRIAL REGISTRATION NCT04040946 , registered August 1, 2019. Protocol version Version 2.1 dated from 2020/04/23.
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Affiliation(s)
- Elske Quak
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Audrey Lasne Cardon
- Department of Head & Neck Surgery, Centre François Baclesse, F-14000 Caen, France
| | - Renaud Ciappuccini
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
- INSERM 1086 ANTICIPE, F-14000 Caen, France
| | - Charline Lasnon
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
- INSERM 1086 ANTICIPE, F-14000 Caen, France
| | - Vianney Bastit
- Department of Head & Neck Surgery, Centre François Baclesse, F-14000 Caen, France
| | - Véronique Le Henaff
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Barbara Lireux
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Gauthier Foucras
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Cyril Jaudet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
| | - Celia Berchi
- INSERM 1086 ANTICIPE, F-14000 Caen, France
- Normandie Univ, UNICAEN, Caen, France
| | | | - Justine Lequesne
- Clinical Research Department, Centre François Baclesse, F-14000 Caen, France
| | - Bénédicte Clarisse
- Clinical Research Department, Centre François Baclesse, F-14000 Caen, France
| | - Stéphane Bardet
- Department of Nuclear Medicine and Thyroid Unit, Centre François Baclesse, Avenue Général Harris, F-14000, 14076 Caen cedex 5, France
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Tsai K, Liang TZ, Grant EG, Swanson MS, Barnett B. Optimal imaging modality for diagnosis of parathyroid adenoma: Case report and review of the literature. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2020. [DOI: 10.1016/j.jecr.2020.100065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Gauthé M, Dierick-Gallet A, Delbot T, Bricaire L, Bertherat J, North MO, Cochand-Priollet B, Bouchard P, Talbot JN, Groussin L, Gaujoux S. 18F-fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism. World J Surg 2020; 44:3761-3769. [PMID: 32681321 DOI: 10.1007/s00268-020-05695-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Primary hyperparathyroidism (HPT1) is the most frequent endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Its surgical management is challenging. We aimed to describe and compare the imaging findings of parathyroid ultrasound (US), sestaMIBI scintigraphy (sestaMIBI), and 18F-fluorocholine (FCH) PET/CT in a series of MEN1 patients with HPT1. METHODS Retrospective analysis of a cohort of MEN1 patients with HPT1 assessed by parathyroid US, sestaMIBI scintigraphy and SPECT/CT, and FCH-PET/CT for potential surgery between 2015 and 2019. RESULTS Twenty-two patients with a confirmed diagnosis of MEN1 who presented with HPT1 and were assessed by the 3 imaging modalities were included. After imaging workups, 11 patients were operated on for the first time, 4 underwent a redo surgery, and 7 did not undergo an operation. The overall patient-based positivity rate of imaging was 91% (20 of 22) for parathyroid US and 96% (21 of 22) for both sestaMIBI and FCH-PET/CT. The 3 imaging modalities demonstrated negative findings in 1/22 patient who did not undergo surgery. Overall, 3 pathologic glands were not detected by any imaging technique. SestaMIBI and FCH-PET/CT both resulted in the same 3 false-positive results in ectopic areas with a significant uptake on two thymic carcinoid tumors and one inflammatory lymph node. FCH-PET/CT provided more surgically relevant data than sestaMIBI in 4/11 patients with initial surgery and in 1/4 patient who underwent redo surgery. CONCLUSIONS Compared to sestaMIBI scintigraphy, FCH-PET/CT provides additional information regarding the number of pathologic parathyroid glands and their localization in MEN1 patients with HPT1.
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Affiliation(s)
- Mathieu Gauthé
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.,AP-HP Health Economics Research Unit, INSERM UMR 1153-CRESS METHODS, Paris, France
| | - Anne Dierick-Gallet
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Thierry Delbot
- Department of Nuclear Medicine, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Léopoldine Bricaire
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France
| | - Jérôme Bertherat
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France.,Université de Paris, Paris, France.,Institut Cochin, Inserm Unité 1016, Centre National de La Recherche Scientifique Unité Mixte de Recherche 8104, Université de Paris, 75014, Paris, France
| | - Marie-Odile North
- Department of Genetic, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Phillipe Bouchard
- Department of Endocrinology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Noël Talbot
- Department of Nuclear Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Lionel Groussin
- Department of Endocrinology, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, 27, rue du Faubourg Saint Jacques, 75014, Paris, France. .,Université de Paris, Paris, France. .,Institut Cochin, Inserm Unité 1016, Centre National de La Recherche Scientifique Unité Mixte de Recherche 8104, Université de Paris, 75014, Paris, France.
| | - Sébastien Gaujoux
- Université de Paris, Paris, France.,Institut Cochin, Inserm Unité 1016, Centre National de La Recherche Scientifique Unité Mixte de Recherche 8104, Université de Paris, 75014, Paris, France.,Department of Pancreatic and Endocrine Surgery, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
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López-Mora DA, Sizova M, Estorch M, Flotats A, Camacho V, Fernández A, Abouzian S, Fuentes-Ocampo F, Garcia JIP, Ballesteros AIC, Duch J, Domènech A, Duarte AM, Carrió I. Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas. Eur J Nucl Med Mol Imaging 2020; 47:572-578. [DOI: 10.1007/s00259-020-04680-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 01/02/2020] [Indexed: 12/14/2022]
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RAYO-MADRID JI, MARTÍNEZ-ESTEVE A, INFANTE DE LA TORRE JR, JIMÉNEZ-GRANERO P, COBO-RODRIGUEZ A, SERRANO-VICENTE J. Cirugía radioguiada de paratiroides. REVISTA ORL 2019. [DOI: 10.14201/orl.21693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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