1
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Grünig H, Strobel K, Zander A, Pérez Lago MDS, Lima T, Wicke C, Fischli S, Bhure U. Significance of incidental thyroid 18F-fluorocholine uptake in patients with hyperparathyroidism imaged for localizing hyperfunctioning parathyroid glands. Nucl Med Commun 2024:00006231-990000000-00324. [PMID: 39101313 DOI: 10.1097/mnm.0000000000001887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
OBJECTIVE 18F-fluorocholine PET/CT is considered the imaging gold standard for detection of hyperfunctioning parathyroid glands . However, increased uptake might also occur in the thyroid gland. The aim of our study was to assess the incidence and significance of 18F-fluorocholine uptake in the thyroid gland in patients with hyperparathyroidism. MATERIALS AND METHODS This retrospective study includes 195 consecutive patients with hyperparathyroidism, who underwent 18F-fluorocholine PET/CT, for detection of hyperfunctioning parathyroid glands. PET/CT images were reviewed by two nuclear medicine physicians for the presence of focal or diffuse thyroid uptake. PET/CT results were compared with laboratory parameters, ultrasonography, EU-TIRADS classification in the presence of thyroid nodules, cytology, and final histology. RESULTS 25 patients (13%) showed 18F-fluorocholine uptake in the thyroid gland: focal thyroid uptake (FTU) in 7 patients (4%), diffuse thyroid uptake (DTU) in 8 patients (4%), and combined uptake (FTU + DTU) in 10 patients (5%), with a total of 20 active thyroid nodules. There was no correlation between EU-TIRADS classification and PET parameters. One highly 18F-fluorocholine active thyroid nodule and one isoactive thyroid nodule turned out to be papillary thyroid cancers in the final histology; 50% of the patients with DTU had Hashimoto's thyroiditis. CONCLUSION Incidental 18F-fluorocholine uptake in the thyroid gland was observed in 13% of patients. As reported for 18F-FDG, focal 18F-fluorocholine uptake might represent thyroid cancer and should be evaluated with ultrasound and, if indicated, with fine-needle aspiration cytology. Diffuse 18F-fluorocholine uptake most likely represents multinodular goiter or Hashimoto's thyroiditis.
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Affiliation(s)
| | | | | | | | - Thiago Lima
- Department of Nuclear Medicine and Radiology
| | | | - Stefan Fischli
- Department of Endocrine Surgery
- Department of Endocrinology, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Ujwal Bhure
- Department of Nuclear Medicine and Radiology
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2
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Petranović Ovčariček P, Calderoni L, Campenni A, Fanti S, Giovanella L. Molecular imaging of thyroid and parathyroid diseases. Expert Rev Endocrinol Metab 2024; 19:317-333. [PMID: 38899737 DOI: 10.1080/17446651.2024.2365776] [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: 03/24/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Molecular imaging of thyroid and parathyroid diseases has changed in recent years due to the introduction of new radiopharmaceuticals and new imaging techniques. Accordingly, we provided an clinicians-oriented overview of such techniques and their indications. AREAS COVERED A review of the literature was performed in the PubMed, Web of Science, and Scopus without time or language restrictions through the use of one or more fitting search criteria and terms as well as through screening of references in relevant selected papers. Literature up to and including December 2023 was included. Screening of titles/abstracts and removal of duplicates was performed and the full texts of the remaining potentially relevant articles were retrieved and reviewed. EXPERT OPINION Thyroid and parathyroid scintigraphy remains integral in patients with thyrotoxicosis, thyroid nodules, differentiated thyroid cancer and, respectively, hyperparathyroidism. In the last years positron-emission tomography with different tracers emerged as a more accurate alternative in evaluating indeterminate thyroid nodules [18F-fluorodeoxyglucose (FDG)], differentiated thyroid cancer [124I-iodide, 18F-tetrafluoroborate, 18F-FDG] and hyperparathyroidism [18F-fluorocholine]. Other PET tracers are useful in evaluating relapsing/advanced forms of medullary thyroid cancer (18F-FDOPA) and selecting patients with advanced follicular and medullary thyroid cancers for theranostic treatments (68Ga/177Ga-somatostatin analogues).
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Affiliation(s)
- Petra Petranović Ovčariček
- Department of Oncology and Nuclear Medicine, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Letizia Calderoni
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
- Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Alfredo Campenni
- Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Unit of Nuclear Medicine, University of Messina, Messina, Italy
| | - Stefano Fanti
- Nuclear Medicine Division, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
- Nuclear Medicine, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine, Gruppo Ospedaliero Moncucco, Lugano, Switzerland
- Clinic for Nuclear Medicine, University Hospital of Zürich, Zürich, Switzerland
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3
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Gulati S, Chumber S, Puri G, Spalkit S, Damle NA, Das CJ. Multi-modality parathyroid imaging: A shifting paradigm. World J Radiol 2023; 15:69-82. [PMID: 37035829 PMCID: PMC10080580 DOI: 10.4329/wjr.v15.i3.69] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/20/2023] [Accepted: 03/01/2023] [Indexed: 03/27/2023] Open
Abstract
The goal of parathyroid imaging in hyperparathyroidism is not diagnosis, rather it is the localization of the cause of hyperparathyroidism for planning the best therapeutic approach. Hence, the role of imaging to accurately and precisely localize the abnormal parathyroid tissue is more important than ever to facilitate minimally invasive parathyroidectomy over bilateral neck exploration. The common causes include solitary parathyroid adenoma, multiple parathyroid adenomas, parathyroid hyperplasia and parathyroid carcinoma. It is highly imperative for the radiologist to be cautious of the mimics of parathyroid lesions like thyroid nodules and lymph nodes and be able to differentiate them on imaging. The various imaging modalities available include high resolution ultrasound of the neck, nuclear imaging studies, four-dimensional computed tomography (4D CT) and magnetic resonance imaging. Contrast enhanced ultrasound is a novel technique which has been recently added to the armamentarium to differentiate between parathyroid adenomas and its mimics. Through this review article we wish to review the imaging features of parathyroid lesions on various imaging modalities and present an algorithm to guide their radiological differentiation from mimics.
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Affiliation(s)
- Shrea Gulati
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Sunil Chumber
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Gopal Puri
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Stanzin Spalkit
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - N A Damle
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - CJ Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
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4
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Shegani A, Kealey S, Luzi F, Basagni F, Machado JDM, Ekici SD, Ferocino A, Gee AD, Bongarzone S. Radiosynthesis, Preclinical, and Clinical Positron Emission Tomography Studies of Carbon-11 Labeled Endogenous and Natural Exogenous Compounds. Chem Rev 2023; 123:105-229. [PMID: 36399832 PMCID: PMC9837829 DOI: 10.1021/acs.chemrev.2c00398] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 11/19/2022]
Abstract
The presence of positron emission tomography (PET) centers at most major hospitals worldwide, along with the improvement of PET scanner sensitivity and the introduction of total body PET systems, has increased the interest in the PET tracer development using the short-lived radionuclides carbon-11. In the last few decades, methodological improvements and fully automated modules have allowed the development of carbon-11 tracers for clinical use. Radiolabeling natural compounds with carbon-11 by substituting one of the backbone carbons with the radionuclide has provided important information on the biochemistry of the authentic compounds and increased the understanding of their in vivo behavior in healthy and diseased states. The number of endogenous and natural compounds essential for human life is staggering, ranging from simple alcohols to vitamins and peptides. This review collates all the carbon-11 radiolabeled endogenous and natural exogenous compounds synthesised to date, including essential information on their radiochemistry methodologies and preclinical and clinical studies in healthy subjects.
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Affiliation(s)
- Antonio Shegani
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Steven Kealey
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Federico Luzi
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Filippo Basagni
- Department
of Pharmacy and Biotechnology, Alma Mater
Studiorum−University of Bologna, via Belmeloro 6, 40126 Bologna, Italy
| | - Joana do Mar Machado
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Sevban Doğan Ekici
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Alessandra Ferocino
- Institute
of Organic Synthesis and Photoreactivity, Italian National Research Council, via Piero Gobetti 101, 40129 Bologna, Italy
| | - Antony D. Gee
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
| | - Salvatore Bongarzone
- School
of Biomedical Engineering & Imaging Sciences, King’s College London, King’s Health Partners, St Thomas’ Hospital, London SE1 7EH, United Kingdom
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5
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Saha S, Vierkant RA, Johnson GB, Parvinian A, Wermers RA, Foster T, McKenzie T, Dy B, Lyden M. C 11 choline PET/CT succeeds when conventional imaging for primary hyperparathyroidism fails. Surgery 2023; 173:117-123. [PMID: 36229257 DOI: 10.1016/j.surg.2022.08.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/14/2022] [Accepted: 08/09/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Focused parathyroidectomy in primary hyperparathyroidism is possible with accurate preoperative localization. A growing body of data exists regarding the role of radio-labeled C11 choline positron emission tomography/computed tomography. In cases of nonlocalized disease, it may be a useful adjunct to ultrasound, (123)I/(99)Tc-sestamibi (I-123 sestamibi), or 4-dimensional computed tomography imaging. METHODS Patients who received a neck and chest limited coverage C11 choline positron emission tomography/computed tomography for evaluation of primary hyperparathyroidism from 2017 to 2021 at a single institution were retrospectively reviewed. We assessed the sensitivity, positive predictive value, and false negative rate. We also compared these rates to the standard modalities of ultrasound, I-123 sestamibi, 4-dimensional computed tomography, and examined concordance rates. RESULTS We identified 43 patients, of whom 33 had a positive C11 choline positron emission tomography/computed tomography finding. This cohort of patients had failed to localize on multiple standard imaging modalities. Twenty-five patients proceeded to surgery, 72% of whom were reoperative cases. Twenty (80%) achieved an intraoperative cure. Analysis showed that C11 choline positron emission tomography/computed tomography achieved a sensitivity of 64% (95% confidence interval 47%-82%) and positive predictive value of 72% (95% confidence interval 54%-90%). There were 5/25 (20%) false positive positron emission tomography C11 choline results found to be lymph nodes, normal parathyroid, and 1 recurrent laryngeal nerve neuroma. CONCLUSION C11 choline positron emission tomography/computed tomography is a useful adjunct for parathyroid localization in a complex population of patients who have failed standard localization techniques including ultrasound, I-123 sestamibi, or 4-dimensional computed tomography and/or prior operations. Although routine inclusion of C11 choline positron emission tomography/computed tomography imaging may not be necessary, it may aid in preoperative localization in the reoperative setting.
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Affiliation(s)
- Sujata Saha
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | | | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology and Department of Immunology, Mayo Clinic, Rochester, MN
| | - Ahmad Parvinian
- Division of Nuclear Medicine, Department of Radiology and Department of Immunology, Mayo Clinic, Rochester, MN
| | - Robert A Wermers
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition and Department of Medicine, Mayo Clinic, Rochester, MN
| | - Trenton Foster
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | - Travis McKenzie
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | - Benzon Dy
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN
| | - Melanie Lyden
- Division of Endocrine and Metabolic Surgery, Mayo Clinic, Rochester, MN.
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6
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Kołodziej M, Saracyn M, Lubas A, Dziuk M, Durma AD, Smoszna J, Zelichowski G, Niemczyk S, Kamiński G. Usefulness of PET/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism. Nutrients 2022; 15:188. [PMID: 36615844 PMCID: PMC9824283 DOI: 10.3390/nu15010188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET/CT with [11C]MET. Results: A positive result of PET/CT was obtained in 89.5% of the patients (17/19). Parathyroidectomy was performed in 52.9% of the patients (9/17) with positive results of PET/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11/19). Ectopic lesions were visualized in 21.1% of the patients (4/19). Conclusions: PET/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed.
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Affiliation(s)
- Maciej Kołodziej
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Marek Saracyn
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Arkadiusz Lubas
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Adam Daniel Durma
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Jerzy Smoszna
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | | | - Stanisław Niemczyk
- Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
| | - Grzegorz Kamiński
- Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland
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7
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Peng ZX, Qin Y, Bai J, Yin JS, Wei BJ. Analysis of the successful clinical treatment of 140 patients with parathyroid adenoma: A retrospective study. World J Clin Cases 2022; 10:10031-10041. [PMID: 36246803 PMCID: PMC9561589 DOI: 10.12998/wjcc.v10.i28.10031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/15/2022] [Accepted: 08/25/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Parathyroid adenoma (PA) sometimes recurs after surgery, how to improve the surgical success rate of PA is the key to the treatment of this disease.
AIM To investigate the clinical features, diagnosis, and surgical treatment of patients with PA.
METHODS Patients who were pathologically confirmed with PA and had undergone surgery for the first time between January 2010 and December 2017 at the Beijing Shijitan Hospital affiliated to Capital Medical University were included in the study. The clinical features, localization diagnosis, and surgical treatment of these patients were analyzed.
RESULTS Of the 140 patients, 32 were male and 108 were female; 132 cases had one adenoma, and 8 had two adenomas. In addition, 114 cases had clinical symptoms, among which 51, 28, 23, 8, and 4 had urinary system, skeletal system, digestive system, neuromuscular system, and neuropsychiatric symptoms, respectively, while 26 cases had no obvious symptoms. The median level of preoperative parathyroid hormone (PTH) was 201.0 pg/mL. The positive detection rate of technetium-99m sestamibi (Tc-99m MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT), ultrasound examination, and the combined use of Tc-99m MIBI SPECT/CT and ultrasound examination was 92.9%, 85.5%, and 96.4%, respectively. Open surgery was performed in all patients, and PTH was monitored during surgery. The success rate of surgery was 98.6%. After surgery, 21 cases developed hypocalcemia, 1 case developed temporary hoarseness, and 19 cases had transient hypoparathyroidism but there was no permanent hypoparathyroidism, postoperative hemorrhage, or hematoma in the surgical area.
CONCLUSION For patients with clinically unexplained skeletal system, urinary system, and neuropsychiatric symptoms, the possibility of PA should be considered. Imaging examinations such as ultrasound and Tc-99m MIBI SPECT/CT could be integrated before surgery to obtain accurate localization diagnosis. Precise preoperative localization, intraoperative PTH monitoring, and delicate surgery to protect the integrity of the PA capsule ensure a minimally invasive and successful surgery.
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Affiliation(s)
- Zhen-Xing Peng
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Yong Qin
- Department of Otorhinolaryngology and Head and Neck Surgery, Peking University First Hospital, Beijing 100034, China
| | - Juan Bai
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Jin-Shu Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Bo-Jun Wei
- Department of Thyroid and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
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8
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Broos WA, Knol RJ, Zant FMVD, Schaper NC, Wondergem M. Incidental Findings on 18F-Fluorocholine PET/CT for Parathyroid Imaging. World J Nucl Med 2022; 21:192-199. [PMID: 36060082 PMCID: PMC9436517 DOI: 10.1055/s-0042-1751031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction
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F-choline positron emission tomography/computed tomography (PET/CT) is an upcoming imaging technique for the localization of hyperfunctioning parathyroid glands. However,
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F-choline is a nonspecific tracer that also accumulates in malignancies, inflammatory lesions, and several other benign abnormalities. The aim of this study was to determine the occurrence and relevance of incidental findings on
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F-choline PET/CT for parathyroid localization.
Materials and Methods
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F-choline PET/CTs performed in our center for parathyroid localization from 2015 to 2019 were reviewed. Abnormal uptake of
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F-choline, with or without anatomical substrate on the co-registered low-dose CT and also incidental findings on CT without increased
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F-choline uptake were recorded. Each finding was correlated with follow-up data from the electronic medical records.
Results
A total of 388
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F-choline PET/CTs were reviewed, with 247 incidental findings detected in 226 patients (58%): 82
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F-choline positive findings with corresponding pathology on CT, 16 without CT substrate, and 149
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F-choline negative abnormalities on CT. Malignant lesions were detected in 10/388 patients (2.6%). Of all 98 detected
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F-choline positive lesions, 15 were malignant (15.3%), concerning 4 metastases and 11 primary malignancies: breast carcinoma (
n
= 7), lung carcinoma (
n
= 2), thyroid carcinoma (
n
= 1), and skin melanoma (
n
= 1).
Conclusion
Clinically relevant incidental findings were observed in a substantial number of patients. In 15.3% of the incidental
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F-choline positive findings, the lesions were malignant. These data contribute to better knowledge of
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F-choline distribution, enhance interpretation of
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F-choline PET/CT, and guide follow-up of incidental findings. Attention should especially be paid to breast lesions in this particular patient group with hyperparathyroidism in which women are typically over-represented.
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Affiliation(s)
- Wouter A.M. Broos
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
- CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
| | - Remco J.J. Knol
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Nicolaas C. Schaper
- CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
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9
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Use of [ 11C]choline PET/CT for visualization of four hyperactive parathyroid glands in a patient with renal hyperparathyroidism. Eur J Nucl Med Mol Imaging 2022; 49:4750-4751. [PMID: 35760966 PMCID: PMC9606055 DOI: 10.1007/s00259-022-05885-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022]
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10
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Petranović Ovčariček P, Giovanella L, Hindie E, Huellner MW, Talbot JN, Verburg FA. An essential practice summary of the new EANM guidelines for parathyroid imaging. 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; 66:93-103. [PMID: 35166093 DOI: 10.23736/s1824-4785.22.03427-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parathyroid imaging is essential for the detection and localization of hyperfunctioning parathyroid tissue in patients with primary hyperparathyroidism (pHPT). Surgical treatment of pHPT mainly consists of minimally invasive parathyroidectomy (MIP), as a single adenoma represents the most common cause of this endocrine disorder. Successful surgery requires an experienced surgeon and relies on the correct preoperative detection and localization of hyperfunctioning parathyroid glands. Failure to preoperatively identify the culprit parathyroid gland by imaging may entail a more invasive surgical approach, including bilateral open neck exploration, with higher morbidity compared to minimally invasive parathyroidectomy. Parathyroid imaging may be also useful before surgery in case of secondary hyperparathyroidism (sHPT) or hereditary disorders (MEN 1, 2, 4) as it enables correct localization of typically located parathyroid glands, detection of ectopic as well as supernumerary glands. It is now accepted by most surgeons experienced in parathyroid surgery that preoperative imaging plays a key role in their patients' management. Recently, the European Association of Nuclear Medicine (EANM) issued an updated version of its Guidelines on parathyroid imaging. Its aim is to precise the role and the advantages and drawbacks of the various imaging modalities proposed or well established in the preoperative imaging strategy. It also aims to favor high performance in indicating, performing, and interpreting those examinations. The objective of the present article is to offer a summary of those recent EANM Guidelines and their originality among other Guidelines in this domain issued by societies of nuclear medicine physicians or other disciplines.
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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 Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland.,Clinic for Nuclear Medicine and Interdisciplinary Thyroid Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Elif Hindie
- 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
| | - Jean-Noël Talbot
- Nuclear Medicine, Hospital Tenon APHP and Sorbonne University, Paris, France
| | - Frederik A Verburg
- EANM Dosimetry Committee.,Erasmus MC, Department of Radiology and Nuclear Medicine, Rotterdam, the Netherlands
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11
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Dekorsy FJ, Beyer L, Spitzweg C, Schmidmaier R, Todica A, Trupka A, Cyran CC, Berger F, Ladurner R, Zimmermann P, Knösel T, Bartenstein P, Lottspeich C, Wenter V. Preoperative Imaging with [ 18F]-Fluorocholine PET/CT in Primary Hyperparathyroidism. J Clin Med 2022; 11:jcm11102944. [PMID: 35629070 PMCID: PMC9143217 DOI: 10.3390/jcm11102944] [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: 04/11/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023] Open
Abstract
Primary hyperparathyroidism (pHPT) is a common endocrine disorder due to hyperfunctioning parathyroid glands. To date, the only curing therapy is surgical removal of the dysfunctional gland, making correct detection and localization crucial in order to perform a minimally invasive parathyroidectomy. 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) has shown promising results for the detection of pHPT, suggesting superiority over conventional imaging with ultrasounds or scintigraphy. A total of 33 patients with pHPT who had negative or equivocal findings in conventional imaging received 18F-FCH PET/CT preoperatively and were retrospectively included. A pathological hyperfunctional parathyroid gland was diagnosed in 24 cases (positive PET, 72.7%), 4 cases showed equivocal choline uptake (equivocal PET, 12.1%), and in 5 cases, no enhanced choline uptake was evident (negative PET, 15.2%). Twelve of the twenty-four detected adenoma patients underwent surgery, and in all cases, a pathological parathyroid adenoma was resected at the site detected by PET/CT. Two of the six patients without pathological choline uptake who received a parathyroidectomy revealed no evidence of parathyroid adenoma tissue in the histopathological evaluation. This retrospective study analyzes 18F-FCH PET/CT in a challenging patient cohort with pHPT and negative or equivocal conventional imaging results and supports the use of 18F-FCH for the diagnosis of hyperfunctional parathyroid tissue, especially in this patient setting, with a 100% true positive and true negative detection rate. Our study further demonstrates the importance of 18F-FCH PET/CT for successful surgical guidance.
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Affiliation(s)
- Franziska J. Dekorsy
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
- Correspondence:
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
| | - Christine Spitzweg
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (R.S.); (C.L.)
| | - Ralf Schmidmaier
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (R.S.); (C.L.)
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
| | - Arnold Trupka
- Department of Endocrine Surgery, Starnberg Hospital, 82319 Starnberg, Germany;
| | - Clemens C. Cyran
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (C.C.C.); (F.B.)
| | - Frank Berger
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (C.C.C.); (F.B.)
| | - Roland Ladurner
- Department of Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (R.L.); (P.Z.)
- Department of Surgery, Martha-Maria Krankenhaus, 81377 Munich, Germany
| | - Petra Zimmermann
- Department of Surgery, University Hospital, LMU Munich, 81377 Munich, Germany; (R.L.); (P.Z.)
| | - Thomas Knösel
- Institute of Pathology, Faculty of Medicine, University Hospital, LMU Munich, 81377 Munich, Germany;
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
| | - Christian Lottspeich
- Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany; (C.S.); (R.S.); (C.L.)
| | - Vera Wenter
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany; (L.B.); (A.T.); (P.B.); (V.W.)
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Zarei A, Karthik S, Chowdhury F, Patel C, Scarsbrook A, Vaidyanathan S. Multimodality imaging in primary hyperparathyroidism. Clin Radiol 2022; 77:e401-e416. [DOI: 10.1016/j.crad.2022.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/25/2022] [Indexed: 11/16/2022]
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13
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Havel M, Dedek V, Kolacek M, Formanek M. Quantitative analysis in parathyroid adenoma scintigraphy. Nucl Med Commun 2022; 43:1-7. [PMID: 34406145 DOI: 10.1097/mnm.0000000000001474] [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: 11/26/2022]
Abstract
OBJECTIVE Surgery is the only curative treatment for primary hyperparathyroidism. Parathyroid scintigraphy is one method used to preoperatively localize the lesion. We examined time-related changes in radiopharmaceutical uptake in parathyroid adenomas (PTAs) and thyroid gland by quantitative single-photon-emission computed tomography (SPECT) imaging to assess differences between rapid and delayed washout patterns. PATIENTS AND METHODS The study group consisted of 35 histologically verified PTAs after radio-guided surgery extirpation in 33 patients with primary hyperparathyroidism. Patients underwent a three-phase SPECT/CT study of the neck and upper thorax post 99mTc-methoxyisobutylisonitrile (MIBI) injection. Images were reconstructed using a proprietary ordered-subset-conjugate-gradient-maximization algorithm (Siemens xSPECT Quant). PTAs were divided into those with a rapid (group A) and those with a slow (group B) washout pattern. SUVmax values of PTAs and thyroid gland tissue at 10, 90 and 180 min post 99mTc-MIBI injection were recorded and statistically assessed. Retention indexes related to the early examination were calculated for PTA and thyroid gland (RI-PTA and RI-TG). RESULTS There were 11 PTAs in group A and 24 in group B. Significant between-group differences in PTA SUVmax and PTA/thyroid gland ratios were observed only at 180 min postinjection (P = 0.0297, P = 0.0222, respectively). RI-PTAs differed significantly at 90 and 180 min postinjection (P = 0.0298, P = 0.0431). No differences in PTA volumes, thyroid gland SUVmax values or RI-TG were observed between the groups. CONCLUSION PTAs with rapid and slow washout patterns have different characteristics on quantitative analysis in later phases. No significant differences in directly measurable quantitative values (SUVmax, PTA/thyroid gland ratio) at the early stages of multi-phase examination were observed.
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Affiliation(s)
| | | | | | - Martin Formanek
- Department of Otorhinolaryngology, University Hospital Ostrava and Medical Faculty, University Ostrava, Ostrava, Czech Republic
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Lenschow C, Wennmann A, Hendricks A, Germer CT, Fassnacht M, Buck A, Werner RA, Plassmeier L, Schlegel N. Questionable value of [ 99mTc]-sestamibi scintigraphy in patients with pHPT and negative ultrasound. Langenbecks Arch Surg 2022; 407:3661-3669. [PMID: 35945299 PMCID: PMC9722861 DOI: 10.1007/s00423-022-02648-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE A successful focused surgical approach in primary hyperparathyroidism (pHPT) relies on accurate preoperative localization of the parathyroid adenoma (PA). Most often, ultrasound is followed by [99mTc]-sestamibi scintigraphy, but the value of this approach is disputed. Here, we evaluated the diagnostic approach in patients with surgically treated pHPT in our center with the aim to further refine preoperative diagnostic procedures. METHODS A single-center retrospective analysis of patients with pHPT from 01/2005 to 08/2021 was carried out followed by evaluation of the preoperative imaging modalities to localize PA. The localization of the PA had to be confirmed intraoperatively by the fresh frozen section and significant dropping of the intraoperative parathyroid hormone (PTH) levels. RESULTS From 658 patients diagnosed with pHPT, 30 patients were excluded from the analysis because of surgery for recurrent or persistent disease. Median age of patients was 58.0 (13-93) years and 71% were female. Neck ultrasound was carried out in 91.7% and localized a PA in 76.6%. In 23.4% (135/576) of the patients, preoperative neck ultrasound did not detect a PA. In this group, [99mTc]-sestamibi correctly identified PA in only 25.4% of patients. In contrast, in the same cohort, the use of [11C]-methionine or [11C]-choline PET resulted in the correct identification of PA in 79.4% of patients (OR 13.23; 95% CI 5.24-33.56). CONCLUSION [11C]-Methionine or [11C]-choline PET/CT are superior second-line imaging methods to select patients for a focused surgical approach when previous ultrasound failed to identify PA.
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Affiliation(s)
- Christina Lenschow
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Andreas Wennmann
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Anne Hendricks
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Martin Fassnacht
- Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Andreas Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Rudolf A. Werner
- Department of Nuclear Medicine, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Lars Plassmeier
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
| | - Nicolas Schlegel
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080 Würzburg, Germany
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Shin M, Choi JY, Kim SW, Kim JH, Cho YS. Usefulness of 99mTc-SESTAMIBI Scintigraphy in Persistent Hyperparathyroidism after Kidney Transplant. Nucl Med Mol Imaging 2021; 55:285-292. [PMID: 34868377 DOI: 10.1007/s13139-021-00722-6] [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: 09/12/2021] [Revised: 10/17/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022] Open
Abstract
Purpose 99mTc-labeled sestamibi scintigraphy combined with single-photon emission computed tomography (SPECT) has a high positive predictive value for localizing hyperfunctioning parathyroid lesions in primary hyperparathyroidism (pHPT) but relatively low sensitivity and specificity in secondary hyperparathyroidism (sHPT) and tertiary hyperparathyroidism (tHPT). The purpose of this study is to investigate the usefulness of 99mTc-sestamibi scintigraphy in persistent hyperparathyroidism after kidney transplant (KT). Methods Retrospectively evaluated 50 patients who received parathyroidectomy after KT at a single medical center. The parathyroid lesion with the highest sestamibi uptake intensity of a patient was graded from 0 to 3. Uptake intensity was analyzed in correlation with parathyroid hormone (PTH), calcium, ionized calcium, phosphorus, and vitamin D. Results Per-patient analysis, 43 patients had hyperplasia, 6 patients had adenomas, and 1 patient had a carcinoma. Only 3 patients with hyperplasia did not demonstrate any sestamibi uptake in the parathyroid scans. Out of the 148 pathologically confirmed parathyroid lesions, SPECT/CT images were able to identify 89 lesions (60%) and planar images of 71 lesions (48%). The average of sestamibi uptake intensity was mild at grade 1.6. Uptake intensity showed a positive correlation with parathyroid hormone (PTH) level but not with phosphorus, calcium, ionized calcium, or vitamin D levels. The largest lesion showed a high positive predictive value, especially in lesions with a diameter over 1.0 cm. Conclusions Regardless of relatively low and less discrete uptake in KT patients, it well depicts the largest and the most hyperfunctioning lesion.
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Affiliation(s)
- Muheon Shin
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Wook Kim
- Department of Endocrinology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Han Kim
- Department of Breast and Endocrine Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Seok Cho
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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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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Oral A, Guvenis A. Improving the detectability of overactive glands in dual-phase parathyroid SPECT/CT: a Monte Carlo simulation study. Biomed Phys Eng Express 2021; 7. [PMID: 34102614 DOI: 10.1088/2057-1976/ac0954] [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: 01/25/2021] [Accepted: 06/08/2021] [Indexed: 11/11/2022]
Abstract
Objective. SPECT-CT is a standard procedure conducted before minimally invasive surgery for the treatment of primary hyperthyroidism. In order to improve image quality, it is important to know how defect detectability is influenced by acquisition and processing parameters. The objective of this study is to continue prior physical phantom optimization studies by performing Monte Carlo simulations for the dual phase parathyroid SPECT-CT protocol using a digital anthropomorphic phantom.Methods. The dual phase parathyroid SPECT-CT imaging procedure with 99mTc-Sestamibi was simulated using the previously extensively validated SIMIND software for the first time. An anthropomorphic ZUBAL based phantom was built to represent an adenoma. Its diameter was set to 0.76 cm which corresponded to more than three times the pixel size and the target-to-background ratio was set to 16:1 based on previous studies. Four different collimators were tested. Contrast-to-noise (CNR) values were determined for different scatter correction options and processing parameter values. The OSEM algorithm was used for image reconstruction.Results. CNR values were improved from about zero (LEGP collimator, 16 iterations, attenuation correction: on, scatter correction: off) up to 3.7 (LEUHR collimator, 16 iterations, attenuation correction: on, scatter correction: off). The subjective visual assessment of detectability on simulated images agreed with the quantitative CNR values.Conclusion. Higher resolution collimators gave better CNR as confirmed by similar studies. The effect of scatter correction was found beneficial only if both the resolution and sensitivity of the collimator were relatively high. This is a significant finding since there is a shortage of definitive guideline on the use of scatter correction for parathyroid SPECT imaging.
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Affiliation(s)
- Aysegul Oral
- Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Cengelkoy, 34684 Istanbul, Turkey
| | - Albert Guvenis
- Institute of Biomedical Engineering, Bogazici University, Kandilli Kampus, Cengelkoy, 34684 Istanbul, Turkey
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Tay D, Das JP, Yeh R. Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review. Biomedicines 2021; 9:biomedicines9040390. [PMID: 33917470 PMCID: PMC8067482 DOI: 10.3390/biomedicines9040390] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 01/02/2023] Open
Abstract
With increasing use of minimally invasive parathyroidectomy (PTx) over traditional bilateral neck exploration in patients with primary hyperparathyroidism (PHPT), accurate preoperative localization has become more important to enable a successful surgical outcome. Traditional imaging techniques such as ultrasound (US) and sestamibi scintigraphy (MIBI) and newer techniques such as parathyroid four-dimension computed tomography (4D-CT), positron emission tomography (PET), and magnetic resonance imaging (MRI) are available for the clinician to detect the diseased gland(s) in the preoperative workup. Invasive parathyroid venous sampling may be useful in certain circumstances such as persistent or recurrent PHPT. We review the diagnostic performance of these imaging modalities in preoperative localization and discuss the advantages and weaknesses of these techniques. US and MIBI are established techniques commonly utilized as first-line modalities. 4D-CT has excellent diagnostic performance and is increasingly performed in first-line setting and as an adjunct to US and MIBI. PET and MRI are emerging adjunct modalities when localization has been equivocal or failed. Since no evidence-based guidelines are yet available for the optimal imaging strategy, clinicians should be familiar with the range and advancement of these techniques. Choice of imaging modality should be individualized to the patient with consideration for efficacy, expertise, and availability of such techniques in clinical practice.
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Affiliation(s)
- Donovan Tay
- Department of Medicine, Sengkang General Hospital, 110 Sengkang E Way, Singapore 544886, Singapore;
| | - Jeeban P. Das
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;
| | - Randy Yeh
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA;
- Correspondence:
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Iconaru L, Spinato L, Duttmann R, Hambye A, Devriendt A, Herchuelz M, Mathey C, Karmali R, Bergmann P. A rare cause of persistent hyperparathyroidism. Clin Case Rep 2021; 9:511-515. [PMID: 33489205 PMCID: PMC7813052 DOI: 10.1002/ccr3.3568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/12/2020] [Accepted: 10/30/2020] [Indexed: 12/30/2022] Open
Abstract
In a case of patient with persistent hypercalcemia after parathyroidectomy, different imaging techniques and particularly 18F-fluorocholine PET/CT are important to localize the adenoma even in a very unusual location.
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Affiliation(s)
- Laura Iconaru
- Department of EndocrinologyCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Linda Spinato
- Department of OtorhinolaryngologyCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Ruth Duttmann
- Department of AnatomopathologyCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Anne‐Sophie Hambye
- Department of Nuclear MedicineCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Arnaud Devriendt
- Department of RadiologyCHU B←rugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Maxime Herchuelz
- Department of Nuclear MedicineCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Celine Mathey
- Department of Nuclear MedicineCUB ErasmeUniversité Libre de BruxellesBrusselsBelgium
| | - Rafik Karmali
- Department of EndocrinologyCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - Pierre Bergmann
- Department of Nuclear MedicineCHU BrugmannUniversité Libre de BruxellesBrusselsBelgium
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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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Abstract
Primary hyperparathyroidism is a hormonal disorder whose prevalence is approximately 1–2% in the United States of America. The disease has become more recognizable to clinicians in an earlier phase and, at present, patients can be diagnosed with “classic”, “normocalcemic”, “normohormonal”, or “mild, asymptomatic” primary hyperparathyroidism. Surgery, with a focused parathyroidectomy when possible, or a four-gland exploration, is the only way to cure the disease. Cure is determined by use of intra-operative parathyroid hormone monitoring with long-term cure rates ranging from 90–95%. Newer adjuncts to surgery include CT or PET imaging and near-infrared immunofluorescence. This article highlights updates in parathyroid disease and advances in parathyroid surgery; it does not provide a comprehensive summary of the disease process or a review of surgical indications, which can be found in the AAES guidelines or NIH Symposium on primary hyperparathyroidism.
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Affiliation(s)
- Melanie Goldfarb
- Center for Endocrine Tumors and Disorders, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, 90404, USA
| | - Frederick R Singer
- Endocrine/Bone Disease Program, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, CA, 90404, USA
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22
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Noltes ME, Kruijff S, Noordzij W, Telenga ED, Vállez García D, Trofimiuk-Müldner M, Opalińska M, Hubalewska-Dydejczyk A, Luurtsema G, Dierckx RAJO, El Moumni M, Boellaard R, Brouwers AH. Optimization of parathyroid 11C-choline PET protocol for localization of parathyroid adenomas in patients with primary hyperparathyroidism. EJNMMI Res 2019; 9:73. [PMID: 31367792 PMCID: PMC6669228 DOI: 10.1186/s13550-019-0534-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/15/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To evaluate the optimal tracer uptake time, the minimal amount of radioactivity and the inter-observer agreement for 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with primary hyperparathyroidism (pHPT). METHODS Twenty-one patients with biochemically proven pHPT were retrospectively studied after injection of 6.3 ± 1.2 MBq/kg 11C-choline. PET data of the first nine patients, scanned for up to 60 min, were reconstructed in 10-min frames from 10- to 60-min postinjection (p.i.), mimicking varying 11C-choline uptake times. Parathyroid adenoma to background contrast ratios were calculated and compared, using standardized uptake values (SUVs). Data was reconstructed with varying scan durations (1, 2.5, 5, and 10 min) at 20-30-min p.i. (established optimal uptake time), mimicking less administered radioactivity. To establish the minimal required radioactivity, the SUVs in the shorter scan durations (1, 2.5, and 5 min) were compared to the 10-min scan duration to determine whether increased variability and/or statistical differences were observed. Four observers analyzed the 11C-choline PET/CT in four randomized rounds for all patients. RESULTS SUVpeak of the adenoma decreased from 30 to 40 p.i. onwards. All adenoma/background contrast ratios did not differ from 20- to 30-min p.i. onwards. The SUVs of adenoma in the scan duration of 1, 2.5, and 5 min all differed significantly from the same SUV in the 10-min scan duration (all p = 0.012). However, the difference in absolute SUV adenoma values was well below 10% and therefore not considered clinically significant. The inter-observer analysis showed that the Fleiss' kappa of the 1-min scan were classified as "moderate," while these values were classified as "good" in the 2.5-, 5-, and 10-min scan duration. Observers scored lower certainty scores in the 1- and 2.5-min scans compared to the 5- and 10-min scan durations. CONCLUSION The optimal time to start PET/CT scanning in patients with pHPT is 20 min after mean injection of 6.3 MBq/kg 11C-choline, with a recommended scan duration of at least 5 min. Alternatively, the radioactivity dose can be lowered by 50% while keeping a 10-min scan duration without losing the accuracy of 11C-choline PET/CT interpretation.
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Affiliation(s)
- Milou E. Noltes
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Schelto Kruijff
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Walter Noordzij
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Eef D. Telenga
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
- Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands
| | - David Vállez García
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | | | - Marta Opalińska
- Nuclear Medicine Unit, Department of Endocrinology, University Hospital, Krakow, Poland
| | | | - Gert Luurtsema
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Rudi A. J. O. Dierckx
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Mostafa El Moumni
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald Boellaard
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
| | - Adrienne H. Brouwers
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, P.O. Box 30 001, 9700 RB Groningen, The Netherlands
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Bertagna F, Albano D, Giovanella L, Giubbini R, Treglia G. F18-choline/C11-choline PET/CT thyroid incidentalomas. Endocrine 2019; 64:203-208. [PMID: 30637562 DOI: 10.1007/s12020-019-01841-z] [Citation(s) in RCA: 10] [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: 11/08/2018] [Accepted: 01/03/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Thyroid incidentaloma is defined as a thyroid lesion incidentally and newly detected by imaging techniques performed for an unrelated purpose and especially for a non-thyroid disease. Aim of this review is to evaluate the prevalence and clinical significance of focal incidental radiolabelled choline uptake in the thyroid gland (CTI) revealed by PET or PET/CT. METHODS A comprehensive computer literature search of the PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles about the prevalence and clinical significance of CTIs detected by PET or PET/CT in patients studied for other oncologic purposes. RESULTS Fifteen articles (14 case reports, one retrospective study on a larger population sample) were included in the systematic review. Considering the case reports, 7/14 CTIs were benign and 7/14 malignant. In the retrospective study on a larger population sample, 14/15 CTIs which underwent further investigations were benign. CONCLUSION Despite very rare but probably underestimated, CTIs frequently signal in the presence of unexpected lesions in the thyroid that differ from the indicated reason for which the patient was initially scanned, and the risk of malignancy is not negligible.
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Affiliation(s)
- Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy.
| | - Domenico Albano
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Giovanella
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Abstract
One of the most promising imaging techniques in primary hyperparathyroidism is PET/CT with choline-based tracers. To investigate the current evidence of these tracers in localizing parathyroid adenoma, a systematic review was performed. A comprehensive literature search was carried out and eligible studies were analyzed. Data were extracted, the level of evidence was scored, and performance data were pooled to calculate the weighted detection rate. Eleven articles were included in this study. The pooled detection rate was 97 and 94% on per patient-based and per lesion-based analysis, respectively. There was considerable heterogeneity between studies and the level of evidence was determined to be 3a-, following Oxford criteria. Choline PET/CT has shown favorable results in detection of hyperfunctioning parathyroid tissue and may replace conventional technetium-99m-sestamibi scintigraphy in preoperative planning of parathyroid surgery. However, the quality of current evidence is moderate, and additional high-quality studies are needed to confirm these numbers.
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Akintayo AA, Abiodun-Ojo OA, Weber C, Sharma J, Cohen C, Sica G, Halkar R, Goodman MM, Schuster DM. Feasibility of Hyperfunctioning Parathyroid Gland Localization Using [ 18F]fluciclovine PET/CT. Mol Imaging Biol 2019; 21:818-824. [PMID: 30617729 DOI: 10.1007/s11307-018-01309-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the ability of anti-1-amino-3-anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid ([18F]fluciclovine) positron emission tomography/X-ray computed tomography (PET/CT) in comparison to Technetium-99m 2-methoxy isobutyl isonitrile ([99mTc]sestamibi) single-photon emission computed tomography/CT (SPECT/CT) for the localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism. PROCEDURES Four patients with hyperparathyroidism underwent 60-minutes sequential neck and thorax PET/CT after [18F]fluciclovine (352 ± 28 MBq) injection. Lesion uptake and target-to-background ratios (TBR) were compared with [99mTc]sestamibi (798 ± 27 MBq) SPECT/CT in the same patient. RESULTS Both techniques detected 4/5 hyperfunctioning parathyroid glands identified at surgery. The highest [18F]fluciclovine uptake and TBRs were at 5-9 min with rapid washout. [99mTc]sestamibi had significantly higher TBRs compared with [18F]fluciclovine (5-9 min) for blood pool (10.9 ± 4.7 vs 1.3 ± 0.6; p < 0.01) and reference muscle backgrounds (5.8 ± 3.0 vs 1.7 ± 0.6; p < 0.01), with non-significant trend for thyroid tissue background (1.3 ± 0.5 vs 1.1 ± 0.5; p = 0.73). CONCLUSION Hyperfunctioning parathyroid glands can be detected on [18F]fluciclovine PET/CT at early imaging, but conspicuity (TBR) is better with [99mTc]sestamibi. [18F]fluciclovine PET/CT does not seem promising in the detection of hyperfunctioning parathyroid glands.
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Affiliation(s)
- Akinyemi A Akintayo
- Department of Radiology and Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, USA.
| | - O A Abiodun-Ojo
- Department of Radiology and Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, USA
| | - C Weber
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - J Sharma
- Department of Surgery, Emory University, Atlanta, GA, USA
| | - C Cohen
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - G Sica
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - R Halkar
- Department of Radiology and Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, USA
| | - M M Goodman
- Department of Radiology and Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, USA
| | - D M Schuster
- Department of Radiology and Imaging Sciences, Division of Nuclear Medicine and Molecular Imaging, Emory University Hospital, 1364 Clifton Road, Atlanta, GA, USA
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Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, Giovanella L. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2018; 46:751-765. [DOI: 10.1007/s00259-018-4123-z] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/01/2018] [Indexed: 02/01/2023]
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Abstract
To give an overview of the potential clinical utility of 18F-fluorocholine PET/CT (FCH PET/CT) in imaging of parathyroid adenoma. Available studies have provided preliminary results of 18F-FCH PET/CT in primary and secondary hyperparathyroidism. Results of various studies have shown that 18F-FCH is a promising upcoming tracer for the detection of parathyroid adenomas, especially when multiple, or having low size. FCH PET/CT has the potential to be a standard investigation in the detection of parathyroid lesions.
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