Correlation Between Clinical Characteristics and Image Parameters of Preoperative ¹⁸F-fluorocholine PET/CT in...

¹⁸F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) is a valuable tool for accurately localizing hyperfunctioning parathyroid lesions. This study investigates the diagnostic value of imaging parameters obtained from preoperative FCH PET/CT for differentiating parathyroid adenoma from hyperplasia in patients with hyperparathyroidism, while considering chronic kidney disease (CKD) status and associated biochemical markers.

A retrospective analysis of 108 patients with 133 lesions who underwent preoperative FCH PET/CT was conducted. PET parameters, including mean and maximum standardized uptake values (SUVmean, SUVmax), choline uptake lesion volume (CULV; volume of the lesion with SUV ≥ 2.5), and total lesion choline uptake (TLCU; calculated as the product of SUVmean and CULV), were measured. Correlations between PET parameters and clinical factors were analyzed using Spearman correlation analysis. Logistic regression analysis was performed to assess the ability of PET parameters and clinical factors to differentiate parathyroid adenoma from hyperplasia.

Significant positive correlations were observed between PTH levels and PET parameters across all patients, with these correlations being notably stronger in CKD-positive patients. CKD was strongly associated with hyperplasia (OR = 60.00, p < 0.001). In multivariable logistic regression analysis adjusted for CKD status, SUVmean remained a significant independent predictor of parathyroid adenoma (OR = 0.306, p = 0.048).

FCH PET/CT reflects the metabolic and pathological characteristics of hyperfunctioning parathyroid lesions. CKD status was a strong independent predictor of hyperplasia, whereas SUVmean independently distinguished adenoma from hyperplasia.