18F-fluorocholine PET/MRI versus ultrasound and sestamibi for the localization of parathyroid adenomas.

Abstract

PURPOSE:

Accurate preoperative localization is imperative to facilitate a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). This study aims to compare the diagnostic value of standard-of-care localization techniques (ultrasound [US] and 99mTechnetium (99mTc) -sestamibi scintigraphy) to [F-18]-fluorocholine positron emission tomography/magnetic resonance imaging (FCH-PET/MRI) to determine the additional clinical usefulness of PET/MRI in a Canadian cohort.

METHODS:

We conducted a prospective, appropriately powered, study to compare the diagnostic value of -FCH PET/MRI to that of the US and 99mTc-sestamibi scintigraphy for localization of parathyroid adenomas in a patient with pHPT. The primary outcome was the per-lesion sensitivity and positive predictive value (PPV) of FCH-PET/MRI, US, and 99mTc-sestamibi scintigraphy. Intraoperative surgeon localization, parathormone levels, and histopathological findings were used as reference standards.

RESULTS:

Forty-one patients underwent FCH-PET/MRI of which 36 patients had parathyroidectomy. In these 36 patients, 41 parathyroid lesions were histologically confirmed as adenomas or hyperplastic glands. Per-lesion sensitivity of FCH-PET/MRI was 82.9% and of US and 99mTc-sestamibi scintigraphy combined at 50.0%, respectively. The sensitivity of FCH-PET/MRI was superior to that of US and 99mTc-sestamibi scintigraphy (p = 0.002). In the 19 patients in whom both US and 99mTc-sestamibi scintigraphy were negative, PET/MRI correctly identified the parathyroid adenoma in 13 patients (68%).

CONCLUSIONS:

FCH-PET/MRI is a highly accurate imaging modality for localization of parathyroid adenomas in a tertiary center in North America. It is a superior functional imaging modality to 99mTc-sestamibi scintigraphy alone and more sensitive for localization of parathyroid lesions than US and 99mTc-sestamibi scintigraphy combined. This imaging modality could become the most valuable preoperative localization study given its superior performance in localizing parathyroid adenomas.

• Authors: M E Noltes, L Rotstein, A Eskander, W P Kluijfhout, P Bongers, A H Brouwers, S Kruijff, U Metser, J D Pasternak, P Veit-Haibach
• Journal: Langenbeck's archives of surgery (Langenbecks Arch Surg) Vol. 408 Issue 1 Pg. 155 (Apr 20 2023) ISSN: 1435-2451 [Electronic] Germany
• PMID: 37079138 (Publication Type: Journal Article)
• Copyright: © 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Chemical References

• fluorocholine
• Radiopharmaceuticals
• fluoromethylcholine
• Technetium Tc 99m Sestamibi
• Organotechnetium Compounds

Topics

• Humans
• Parathyroid Neoplasms (diagnostic imaging, surgery)
• Prospective Studies
• Hyperparathyroidism, Primary (surgery)
• Canada
• Positron-Emission Tomography (methods)
• Parathyroid Glands (diagnostic imaging, surgery, pathology)
• Radiopharmaceuticals
• Technetium Tc 99m Sestamibi
• Organotechnetium Compounds
• Magnetic Resonance Imaging