Detectability of 18F-choline PET/MR in primary hyperparathyroidism

Area of Science:

• Nuclear Medicine
• Radiology
• Endocrinology

Background:

• Primary hyperparathyroidism diagnosis often relies on accurate localization of parathyroid adenomas.
• Unlocalized or equivocal cases present a challenge for surgical planning.
• 18F-fluorocholine (FCH) PET/CT has emerged as a valuable tool, but its efficacy in conjunction with MRI needs further evaluation.

Purpose of the Study:

• To evaluate the diagnostic power of 18F-fluorocholine positron emission tomography/magnetic resonance (PET/MR) imaging for unlocalized primary hyperparathyroidism.
• To compare the performance of PET/MR with standalone PET and MR imaging in localizing parathyroid adenomas.

Main Methods:

• A study included 34 patients with primary hyperparathyroidism.
• 18F-FCH PET/MR was performed, with 17 patients having undergone a prior negative 18F-FCH PET/CT.
• Sensitivity, specificity, and predictive values were calculated for MR-only and PET-only findings, blinded to the other modality.

Main Results:

• 18F-FCH PET/MR demonstrated positivity in 76% (26/34) of patients, including 71% (12/17) with prior negative PET/CT.
• In cases with discordant PET-only and MR-only results (32%), MR was false positive in 7 patients.
• PET/MR achieved 100% sensitivity, specificity, PPV, NPV, and accuracy, outperforming blinded MR-only analysis (80%, 50%, 70%, 64%, 68% respectively).

Conclusions:

• 18F-fluorocholine PET/MR is highly effective for preoperative localization of parathyroid adenomas, particularly in cases with negative 18F-FCH PET/CT.
• Neck MR alone is insufficient for parathyroid adenoma detection.
• The combination of PET/MR enhances precise localization, improving surgical outcomes.