Parathyroid imaging by 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and inconclusive conventional methods: clinico-pathological correlations.

摘要

18F-fluorocholine positron emission tomography/computedtomography (FCH) was performed after inconclusive neckultrasound and 99Tc-sestaMIBI SPECT (MIBI) scintigraphy inpatients with primary hyperparathyroidism (PHPT) to localizeabnormal parathyroid glands before surgery. The results wereretrospectively evaluated and compared to postoperativehistopathological findings. 13 patients with PHPT were enrolled(mean age 64.3 years, preoperative calcium 2.74 mmol/l andparathyroid hormone 114.6 ng/l). FCH localized hyperfunctioningparathyroid glands in 12 patients of 13 (per patient sensitivity92 % and positive predictive value (PPV) 100 %). Fourteenparathyroid lesions (11 adenomas, 3 hyperplastic glands) wereresected with a mean size of 11.9 mm (per lesion sensitivity93 % and PPV 81 %). Four adenomas and one hyperplastic glandwere composed of only chief cells, whereas five lesions containedboth chief and oxyphil cells. In three patients an exclusivelyoxyphil adenoma was found, surprisingly with negative MIBIscintigraphy in spite of a high mitochondria content in the oxyphilparathyroid cells. 12 of 13 patients had thyroid disease. In ourlimited study sample, FCH correctly identified parathyroidadenomas and/or hyperplastic glands in 92 % of patients withpreviously inconclusive conventional imaging. Unlike MIBI, FCHsuccessfully localized small, hyperplastic and multiplehyperfunctioning parathyroid glands, irrespective of theirhistopathological composition.