Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder. Definitive treatment is surgical. Preoperative localization of diseased glands increases the chance of successful treatment. The aim of this study is to investigate the diagnostic performance of F-fluoromethylcholine-positron emission tomography-computed tomography (F-FCh-PET-CT) in preoperative localization of diseased parathyroid glands, when first-line examinations were inconclusive.
Methods: This is a retrospective study. All patients with PHPT who underwent F-FCh-PET-CT, after inconclusive ultrasound examination and Tc-methoxyisobutylisonitrile/single-photon emission CT-CT, were included in cohort I. Patients who were subsequently operated for their parathyroid disease, were included in cohort II. The performance of F-FCh-PET-CT was analyzed in two sets: per-lesion, and per-gland analysis.
Results: Out of 52 patients in cohort I, F-FCh-PET-CT identified single or multiple parathyroid lesions in 43 patients (83%). Nine patients had multiglandular disease. Thirty-four (65%) patients were subsequently operated and included in cohort II. Forty-four lesions were removed from these patients and 33 patients (97%) were cured. F-FCh-PET-CT localized 40 out of 44 lesions, with per-lesion and per-gland sensitivities of 97% and 95%, and positive predictive values (PPVs) of 93% and 87%, respectively, in addition to a specificity of 97% and a negative predictive value (NPV) of 94% in the per-gland analysis. Comparable excellent results were detected in multiglandular disease with sensitivity of 94.1%, specificity of 89%, PPV of 84%, and NPV of 94%.
Conclusions: Our study demonstrates the high diagnostic performance of F-FCh-PET-CT in the preoperative localization of diseased parathyroid gland in patients with PHPT, especially in multiglandular PHPT.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10721563 | PMC |
| http://dx.doi.org/10.21037/gs-23-232 | DOI Listing |
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