Primary Hyperparathyroidism: 18F-Fluorocholine PET/CT vs. 4D-CT for Parathyroid Identification: Toward a...

Area of Science:

• Endocrinology
• Nuclear Medicine
• Radiology

Background:

• Primary hyperparathyroidism (pHPT) is an endocrine disorder caused by excessive parathyroid hormone.
• Accurate preoperative localization of parathyroid adenomas is crucial for surgical planning, especially for minimally invasive surgery.
• First-line imaging (ultrasound, 99mTc-sestamibi scintigraphy) may be inconclusive in some pHPT cases.

Purpose of the Study:

• To review and recommend the role of advanced imaging techniques in localizing parathyroid adenomas.
• To provide updated guidance on using 18F-fluorocholine PET/CT (FCH-PET) and four-dimensional computed tomography (4D-CT) for pHPT.

Main Methods:

• Review of current literature and recommendations for advanced imaging in pHPT.
• Analysis of diagnostic performance of FCH-PET and 4D-CT in parathyroid adenoma localization.

Main Results:

• 18F-fluorocholine PET/CT demonstrates high sensitivity (94% per patient, 96% per lesion) for detecting parathyroid adenomas, including small or ectopic ones.
• 4D-CT provides detailed anatomical imaging, valuable for complex cases like recurrent disease or ectopic glands.
• FCH-PET and 4D-CT show comparable diagnostic performance and can be complementary in challenging preoperative planning.

Conclusions:

• A multimodal imaging approach is recommended, utilizing advanced techniques when initial diagnostics are uncertain.
• 18F-fluorocholine PET/CT is a favored second-line option, while 4D-CT is essential for its high spatial resolution in complex cases.
• These advanced modalities significantly improve parathyroid localization accuracy, leading to more targeted and minimally invasive surgical outcomes.