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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] [What about the content of this article? (0)] [Affiliation(s)] [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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