Evaluating Fluorine-18-Fluorocholine Positron Emission Tomography/Computed Tomography as a First-Line Imaging...

For treatment of hyperparathyroidism, accurate detection of potential parathyroid adenomas is crucial prior to surgical removal. Fluorine-18-fluorocholine (FCH) positron emission tomography (PET)/computed tomography (CT) has emerged as an alternative to previous imaging procedures, and literature shows superior diagnostic performance. This study aimed to evaluate FCH-PET/CT as a first-line procedure for localizing potential parathyroid adenomas in a real-world setting and establish benefits and challenges of adopting this procedure.

Patients referred for hyperparathyroidism imaging had FCH-PET/CT performed as first-line procedure. The diagnostic performance was determined from histopathology on both per-patient and per-lesion levels and 6-month biochemical follow-up. The radiation burden and acquisition duration were determined to evaluate patient benefits. Imaging descriptions and surgical reports were examined to uncover any challenges.

Fifty-eight patients were included, of whom 39 had undergone parathyroidectomy at the time of data collection. Per-patient results were as follows: (1) sensitivity of 97.4% and (2) positive predictive value of 100%. Per-lesion results were as follows: (1) sensitivity of 82.6% and (2) positive predictive value of 97.4%. Compared with the previous imaging procedure, patients experienced a 43% reduction in radiation burden and an 82% reduction in acquisition time. Histopathology revealed a superiority in detecting adenomas over hyperplasia. Additionally, detecting adenomas and hyperplasia located intrathyroidally was challenging.

FCH-PET/CT yields a high diagnostic performance in clinical practice, thus making it one of the reliable first-line imaging procedures. Despite several benefits, the procedure holds challenges with regard to hyperplasia detection and intrathyroidally located adenomas. These observations from an early adopting center should be in consideration for other sites, looking to implement FCH-PET/CT as a first-line imaging procedure in clinical practice.