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

M E Noltes; L Rotstein; A Eskander; W P Kluijfhout; P Bongers; A H Brouwers; S Kruijff; U Metser; J D Pasternak; P Veit-Haibach

doi:10.1007/s00423-023-02893-6

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

Langenbecks Arch Surg. 2023 Apr 20;408(1):155. doi: 10.1007/s00423-023-02893-6.

Authors

M E Noltes^{1

2

3}, L Rotstein³, A Eskander⁴, W P Kluijfhout³, P Bongers^{1

3}, A H Brouwers², S Kruijff^{1

2}, U Metser⁵, J D Pasternak^#⁶, P Veit-Haibach^#⁵

Affiliations

¹ University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands.
² University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands.
³ Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Otolaryngology-Head and Neck Surgery, Michael Garron Hospital, University of Toronto, Toronto, Ontario, Canada.
⁵ Toronto Joint Department Medical Imaging, University Health Network, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
⁶ Section of Endocrine Surgery, Division of General Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. jesse.pasternak@uhn.ca.

^# Contributed equally.

PMID: 37079138
DOI: 10.1007/s00423-023-02893-6

Abstract

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 ^99mTechnetium (^99mTc) -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 ^99mTc-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 ^99mTc-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 ^99mTc-sestamibi scintigraphy combined at 50.0%, respectively. The sensitivity of FCH-PET/MRI was superior to that of US and ^99mTc-sestamibi scintigraphy (p = 0.002). In the 19 patients in whom both US and ^99mTc-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 ^99mTc-sestamibi scintigraphy alone and more sensitive for localization of parathyroid lesions than US and ^99mTc-sestamibi scintigraphy combined. This imaging modality could become the most valuable preoperative localization study given its superior performance in localizing parathyroid adenomas.

Keywords: Magnetic resonance imaging; Nuclear imaging; Parathyoidectomy; Parathyroid; Primary hyperparathyroidism; [F-18]-fluorocholine PET.

MeSH terms

Canada
Humans
Hyperparathyroidism, Primary* / surgery
Magnetic Resonance Imaging
Organotechnetium Compounds
Parathyroid Glands / diagnostic imaging
Parathyroid Glands / pathology
Parathyroid Glands / surgery
Parathyroid Neoplasms* / diagnostic imaging
Parathyroid Neoplasms* / surgery
Positron-Emission Tomography / methods
Prospective Studies
Radiopharmaceuticals
Technetium Tc 99m Sestamibi

Substances

fluorocholine
Radiopharmaceuticals
fluoromethylcholine
Technetium Tc 99m Sestamibi
Organotechnetium Compounds