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18F-fluorocholine PET/MRI versus ultrasound and sestamibi for the localization of parathyroid adenomas

Purpose Accurate preoperative localization is imperative to facilitate a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). This study aims to compare the diagnostic value of standard-of-care localization techniques (ultrasound [US] and 99m Technetium ( 99m Tc) -sestam...

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Published in:Langenbeck's archives of surgery 2023-04, Vol.408 (1), p.155-155, Article 155
Main Authors: Noltes, ME, Rotstein, L, Eskander, A, Kluijfhout, WP, Bongers, P, Brouwers, A. H., Kruijff, S., Metser, U., Pasternak, JD, Veit-Haibach, P.
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Language:English
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Summary:Purpose Accurate preoperative localization is imperative to facilitate a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). This study aims to compare the diagnostic value of standard-of-care localization techniques (ultrasound [US] and 99m Technetium ( 99m Tc) -sestamibi scintigraphy) to [F-18]-fluorocholine positron emission tomography/magnetic resonance imaging (FCH-PET/MRI) to determine the additional clinical usefulness of PET/MRI in a Canadian cohort. Methods We conducted a prospective, appropriately powered, study to compare the diagnostic value of -FCH PET/MRI to that of the US and 99m Tc-sestamibi scintigraphy for localization of parathyroid adenomas in a patient with pHPT. The primary outcome was the per-lesion sensitivity and positive predictive value (PPV) of FCH-PET/MRI, US, and 99m Tc-sestamibi scintigraphy. Intraoperative surgeon localization, parathormone levels, and histopathological findings were used as reference standards. Results Forty-one patients underwent FCH-PET/MRI of which 36 patients had parathyroidectomy. In these 36 patients, 41 parathyroid lesions were histologically confirmed as adenomas or hyperplastic glands. Per-lesion sensitivity of FCH-PET/MRI was 82.9% and of US and 99m Tc-sestamibi scintigraphy combined at 50.0%, respectively. The sensitivity of FCH-PET/MRI was superior to that of US and 99m Tc-sestamibi scintigraphy ( p = 0.002). In the 19 patients in whom both US and 99m Tc-sestamibi scintigraphy were negative, PET/MRI correctly identified the parathyroid adenoma in 13 patients (68%). Conclusions FCH-PET/MRI is a highly accurate imaging modality for localization of parathyroid adenomas in a tertiary center in North America. It is a superior functional imaging modality to 99m Tc-sestamibi scintigraphy alone and more sensitive for localization of parathyroid lesions than US and 99m Tc-sestamibi scintigraphy combined. This imaging modality could become the most valuable preoperative localization study given its superior performance in localizing parathyroid adenomas.
ISSN:1435-2451
1435-2451
DOI:10.1007/s00423-023-02893-6