[Imaging of parathyroid adenomas with F‑18 choline PET-CT]

Ultrasound and sestamibi scintigraphy are the recommended standard procedures for initial diagnosis in primary hyperparathyroidism (pHPT). Recently, F‑18 choline positron emission tomography computed tomography (choline PET/CT) has been shown promising results for the diagnostic work up of primary hyperparathyroidism (pHPT) suggesting superiority over conventional scintigraphy using Tc99m sestamibi based protocols using planar dual-phase imaging, SPECT or SPECT/CT.

This review presents the results of F‑18 choline PET/CT on the basis of a literature search using the keywords "primary hyperparathyroidism and choline", "primary hyperparathyroidism and PET", "parathyroid adenoma and choline" und "parathyroid adenoma and PET".

6 studies were identified dealing with the diagnostic impact of choline PET/CT. The studies included 5 to 151 patients. Localization of single gland adenomas can be achieved with choline PET/CT in 80 up to 96% of cases. A high sensitivity and accuracy of choline PET/CT imaging is documented even in cases of repeated surgery for recurrent pHPT, in coexistant nodular goiter or in the detection of adenoma in atypical localization.

Using choline PET/CT parathyroid adenoma and probably parathyroid hyperplasia can be exactly localized in most patients with pHPT. Thus, a minimal-invasive surgical procedure is feasible with decreased risk of complications but high success rate in terms of biochemical cure. The diagnostic accuracy in multiglandular disease remains to be established.