Abstract

PURPOSE:

• Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and / or ^99mTc-Sestamibi scintigraphy:
  • Can be challenging
• PET / CT with ¹⁸F-Fluorocholine (¹⁸F-FCH):
  • Might improve the detection of pathologic parathyroid glands
• The aim of this study was to compare the diagnostic performance of ¹⁸F-FCH-PET / CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US

METHODS:

• Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, seven had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism.
• All patients underwent:
  • High-resolution neck US
  • Dual-phase dual-isotope ^99mTc-Pertechnetate / ^99mTc-Sestamibi scintigraphy
  • ¹⁸F-FCH-PET / CT

RESULTS:

• In the whole patients’ group, the detection rates of the abnormal parathyroid gland were:
  • 68% for neck US
  • 71% for ¹⁸F-FCH-PET / CT
  • 15% for ^99mTc-Sestamibi scintigraphy
• The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were:
  • 57% and 70% for neck US
  • 70% and 71% for ¹⁸F-FCH-PET / CT
  • 0% and 18% for ^99mTc-Sestamibi scintigraphy
• In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology / biochemistry:
  • The correct detection rate was:
    • 82% for neck US
    • 89% for ¹⁸F-FCH-PET / CT
    • 17% for ^99mTc-Sestamibi scintigraphy

CONCLUSIONS:

• ¹⁸F-FCH-PET / CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small