Head-to-head comparison of [11C]methionine PET, [11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism

• Published in: European journal of nuclear medicine and molecular imaging 2024-03, Vol.51 (4), p.1050-1059
• Main Authors: Noltes, Milou E., Kruijff, Schelto, Appelman, Auke P. A., Jansen, Liesbeth, Zandee, Wouter T., Links, Thera P., van Hemel, Bettien M., Schouw, Hugo M., Dierckx, Rudi A. J. O., Francken, Anne Brecht, Kelder, Wendy, van der Hoorn, Anouk, Brouwers, Adrienne H.
• Format: Article
• Language: English
• Subjects: Adenoma; Calcium (blood); Cardiology; Choline; Cohort Studies; Computed tomography; Humans; Hyperparathyroidism; Hyperparathyroidism, Primary - diagnostic imaging; Hyperparathyroidism, Primary - surgery; Imaging; Imaging techniques; Lesions; Localization; Medical imaging; Medicine; Medicine & Public Health; Methionine; Nuclear Medicine; Oncology; Original; Original Article; Orthopedics; Parathyroid; Parathyroid Glands; Parathyroid Neoplasms - complications; Parathyroid Neoplasms - diagnostic imaging; Patients; Positron emission; Positron Emission Tomography Computed Tomography - methods; Prospective Studies; Racemethionine; Radiology; Sensitivity analysis; Surgery; Technetium Tc 99m Sestamibi; Tumors
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-023-06488-7

Purpose Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [ 11 C]methionine PET/CT, [ 11 C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan. Methods We conducted a powered, prospective, blinded cohort study in patients with biochemically proven pHPT and prior negative or discordant first-line imaging consisting of ultrasonography and 99m Tc-sestamibi. All patients underwent [ 11 C]methionine PET/CT, [ 11 C]choline PET/CT, and 4D-CT. At first, all scans were interpreted by a nuclear medicine physician, and a radiologist who were blinded from patient data and all imaging results. Next, a non-blinded scan reading was performed. The scan results were correlated with surgical and histopathological findings. Serum calcium values at least 6 months after surgery were used as gold standard for curation of HPT. Results A total of 32 patients were included in the study. With blinded evaluation, [ 11 C]choline PET/CT was positive in 28 patients (88%), [ 11 C]methionine PET/CT in 23 (72%), and 4D-CT in 15 patients (47%), respectively. In total, 30 patients have undergone surgery and 32 parathyroid lesions were histologically confirmed as parathyroid adenomas. Based on the blinded evaluation, lesion-based sensitivity of [ 11 C]choline PET/CT, [ 11 C]methionine PET/CT, and 4D-CT was respectively 85%, 67%, and 39%. The sensitivity of [ 11 C]choline PET/CT differed significantly from that of [ 11 C]methionine PET/CT and 4D-CT ( p  = 0.031 and p