A novel imaging approach in hyperparathyroidism: [68Ga]Ga-Trivehexin PET/CT

Area of Science:

• Nuclear medicine
• Radiopharmaceuticals
• Medical imaging

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
• Accurate localization of hyperfunctioning parathyroid tissue is crucial for surgical planning.
• Current imaging modalities have limitations in detecting all affected parathyroid glands.

Purpose of the Study:

• To evaluate the diagnostic performance of [68Ga]Ga-Trivehexin PET/CT for localizing hyperfunctioning parathyroid tissue in PHPT.
• To compare the efficacy of [68Ga]Ga-Trivehexin PET/CT with [99mTc]Tc-MIBI scintigraphy with SPECT/CT (MIBI scan).

Main Methods:

• Retrospective study of patients with biochemically confirmed PHPT who underwent both MIBI scan and [68Ga]Ga-Trivehexin PET/CT.
• Comparison of patient- and lesion-based detection rates between the two imaging modalities.
• Assessment of quantitative parameters (SUVmax, lesion-to-background ratios) and subgroup analysis (MEN-1, post-surgical disease).

Main Results:

• [68Ga]Ga-Trivehexin PET/CT correctly localized hyperfunctioning tissue in 92% of patients, versus 74% for MIBI scan (P < 0.05).
• [68Ga]Ga-Trivehexin PET/CT detected 98% of lesions (49/50) compared to 58% for MIBI scan (29/50).
• Distinct uptake was seen in 18 lesions with negative/equivocal MIBI findings; early imaging was sufficient.

Conclusions:

• [68Ga]Ga-Trivehexin PET/CT demonstrates superior detection rates for hyperfunctioning parathyroid tissue in PHPT.
• The modality is particularly effective for multiglandular and subcentimetric disease.
• Early [68Ga]Ga-Trivehexin PET/CT acquisition is sufficient, with limited benefit from delayed imaging.