Choline PET/CT in parathyroid imaging: a systematic review.

Area of Science:

• Nuclear Medicine
• Oncology Imaging

Background:

• Primary hyperparathyroidism diagnosis and surgical planning rely on accurate localization of parathyroid adenomas.
• Conventional imaging techniques like technetium-99m-sestamibi scintigraphy have limitations in sensitivity and specificity.

Purpose of the Study:

• To systematically review the evidence on the efficacy of positron emission tomography/computed tomography (PET/CT) with choline-based tracers for localizing parathyroid adenomas.
• To determine the pooled detection rate and assess the level of evidence for choline PET/CT in primary hyperparathyroidism.

Main Methods:

• A comprehensive literature search was conducted to identify eligible studies.
• Data extraction, quality scoring, and performance data pooling were performed to calculate the weighted detection rate.
• Eleven articles were included in the systematic review.

Main Results:

• The pooled detection rate for choline PET/CT was 97% on a per-patient basis and 94% on a per-lesion basis.
• Considerable heterogeneity was observed among the included studies.
• The level of evidence was determined to be 3a- according to Oxford criteria.

Conclusions:

• Choline PET/CT demonstrates promising results for detecting hyperfunctioning parathyroid tissue, potentially aiding in preoperative planning for parathyroid surgery.
• While effective, the current evidence quality is moderate, necessitating further high-quality studies to validate these findings.
• Choline PET/CT may represent a future replacement for technetium-99m-sestamibi scintigraphy.