PETC/CT with ¹⁸F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic...

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. We aimed at comparing the diagnostic performance of ¹⁸F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US.

Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 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, and ¹⁸F-FCH-PET/CT.

In the whole patients' group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for ¹⁸F-FCH-PET/CT, and only 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, and 0 and 18% for ^99mTc-Sestamibi scintigraphy, respectively. 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, and only 17% for ^99mTc-Sestamibi scintigraphy.

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.