Diagnostic Reliability and Clinical Impact of [¹¹C]Choline PET/CT for Detecting Hyperfunctioning Parathyroid Glands

Area of Science:

• Nuclear Medicine
• Radiology
• Endocrinology

Background:

• Clinical hyperparathyroidism (cHPT) diagnosis relies on biochemical confirmation.
• Accurate preoperative localization of hyperfunctioning parathyroid glands is crucial for successful surgical intervention.
• Conventional imaging modalities have limitations in detecting and localizing parathyroid adenomas.

Purpose of the Study:

• To evaluate the diagnostic performance and robustness of [¹¹C]choline PET/CT for preoperative localization of hyperfunctioning parathyroid glands in patients with cHPT.
• To assess the interobserver agreement in interpreting [¹¹C]choline PET/CT scans for parathyroid adenoma detection and localization.

Main Methods:

• Retrospective analysis of 174 patients with biochemically proven cHPT who underwent [¹¹C]choline PET/CT for preoperative localization.
• Review of patient data including hormone levels, calcium metabolism, and prior imaging results.
• Histopathology served as the reference standard for diagnostic performance assessment in surgically treated patients.

Main Results:

• Moderate interobserver agreement was observed for both examination positivity (κ=0.636) and gland localization (κ=0.656).
• Patient-based analysis demonstrated a sensitivity of 92.2% and a positive predictive value of 98.3% for [¹¹C]choline PET/CT.
• Lesion-based analysis yielded a sensitivity of 88.2% and a positive predictive value of 96.8%.
• The cure rate for cHPT following [¹¹C]choline PET/CT-guided surgery was 84.1%.

Conclusions:

• [¹¹C]choline PET/CT is a diagnostically effective imaging technique for patients with cHPT.
• The promising diagnostic performance necessitates refinement of interpretation criteria, especially for ectopic gland localization, to enhance its clinical utility.