18F-fluorocholine PET/CT and conventional imaging in primary hyperparathyroidism.

Area of Science:

• Nuclear Medicine
• Radiology
• Endocrinology

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
• Accurate preoperative localization of hyperfunctioning parathyroid glands is crucial for successful surgical management.
• Conventional imaging modalities have limitations in detecting all abnormal parathyroid glands.

Purpose of the Study:

• To evaluate the diagnostic performance of 99mTc-MIBI scintigraphy, cervical ultrasonography (CUS), and 18F-fluorocholine PET/CT (FCH PET/CT) for detecting hyperfunctioning parathyroid glands in PHPT.
• To compare the effectiveness of each imaging modality used alone versus as a combined imaging set.

Main Methods:

• Retrospective analysis of 51 PHPT patients who underwent CUS, 99mTc-MIBI scintigraphy, and FCH PET/CT.
• Independent interpretation of each modality, followed by a consensus reading of the combined imaging set.
• Histopathological analysis of surgically removed lesions for confirmation.

Main Results:

• The combined imaging set achieved a sensitivity of 94%, significantly higher than individual modalities (FCH PET/CT: 76%, CUS: 71%, 99mTc-MIBI: 33%).
• FCH PET/CT and CUS demonstrated comparable sensitivity and accuracy when used alone.
• 99mTc-MIBI scintigraphy showed the lowest sensitivity and accuracy among the evaluated techniques.

Conclusions:

• Interpreting CUS, 99mTc-MIBI scintigraphy, and FCH PET/CT as a combined imaging set is recommended for precise preoperative localization of parathyroid lesions in PHPT patients.
• A multimodal imaging approach enhances diagnostic accuracy for surgical planning in PHPT.