Preoperative Imaging with [¹⁸F]-Fluorocholine PET/CT in Primary Hyperparathyroidism

Area of Science:

• Endocrinology
• Nuclear Medicine
• Surgical Oncology

Background:

• Primary hyperparathyroidism (pHPT) is a common endocrine disorder characterized by overactive parathyroid glands.
• Surgical removal of the dysfunctional gland is the only curative treatment for pHPT.
• Accurate preoperative localization of hyperfunctioning parathyroid tissue is essential for successful minimally invasive parathyroidectomy.

Purpose of the Study:

• To evaluate the diagnostic performance of 18F-Fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) in patients with pHPT and inconclusive conventional imaging.
• To assess the utility of 18F-FCH PET/CT in guiding surgical interventions for pHPT.

Main Methods:

• Retrospective analysis of 33 patients with pHPT and negative or equivocal conventional imaging results.
• Preoperative 18F-FCH PET/CT was performed on all included patients.
• Surgical outcomes and histopathological evaluations were correlated with PET/CT findings.

Main Results:

• 18F-FCH PET/CT correctly identified hyperfunctional parathyroid glands in 72.7% of patients (positive PET).
• In patients who underwent surgery based on PET/CT findings, there was a 100% true positive and true negative detection rate.
• The study demonstrated a 100% concordance between PET/CT localization and successful surgical resection of parathyroid adenomas.

Conclusions:

• 18F-FCH PET/CT is a valuable tool for diagnosing hyperfunctional parathyroid tissue, particularly in challenging pHPT cases with negative or equivocal conventional imaging.
• The high accuracy of 18F-FCH PET/CT supports its use for preoperative localization, significantly enhancing the success of minimally invasive parathyroidectomy.