1 Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
AJR Am J Roentgenol. 2018 Feb;210(2):418-422. doi: 10.2214/AJR.17.18312. Epub 2017 Nov 15.
The purpose of this study is to determine the efficacy of C-choline PET/CT for the detection of parathyroid adenomas by retrospectively reviewing a large patient population.
In this single-institution retrospective study, 7088 C-choline PET/CT scans performed of 2933 men with prostate cancer from January 2005 through February 2016 were evaluated. Patients with suspected parathyroid adenomas were identified through a review of the electronic medical record and relevant imaging. Patient demographics, laboratory results, and lesion characteristics were noted. Pathologically proven parathyroid adenomas and lesions in patients with imaging or laboratory findings consistent with the diagnosis were considered positive.
Thirteen men (mean [± SD] age, 72 ± 7 years) with pathologically or laboratory-proven parathyroid adenomas were identified. All had abnormally elevated serum calcium and parathyroid hormone levels. All adenomas were tracer avid on C-choline PET/CT (maximum standardized uptake value, 5.6 ± 3.0), with activity averaging 4.2 times that of the blood pool and 2.1 times that of the adjacent thyroid. One case of an ectopic adenoma was identified. Of the six pathologically confirmed cases, none displayed high-grade features such as capsular, vascular, or adjacent tissue invasion. Three additional patients with possible parathyroid adenomas at C-choline PET/CT were ultimately found to have thyroid lesions on the basis of tissue diagnosis; however, none of these patients had abnormal calcium or parathyroid hormone levels.
In our patient population, C-choline PET/CT identified parathyroid adenomas with high specificity. Prospective investigation is warranted to validate this result and delineate the utility of C-choline PET/CT relative to other modalities.
本研究旨在通过回顾性分析大量患者人群，确定 C-胆碱 PET/CT 检测甲状旁腺腺瘤的疗效。
在这项单中心回顾性研究中，对 2005 年 1 月至 2016 年 2 月期间 2933 例前列腺癌男性患者的 7088 次 C-胆碱 PET/CT 扫描进行了评估。通过查阅电子病历和相关影像学资料，确定疑似甲状旁腺腺瘤患者。记录患者的人口统计学、实验室结果和病变特征。经病理证实的甲状旁腺腺瘤以及影像学或实验室检查结果与诊断相符的患者中的病变被认为是阳性。
13 例（平均年龄 [±标准差]，72±7 岁）经病理或实验室证实为甲状旁腺腺瘤的男性患者被识别。所有患者均有异常升高的血清钙和甲状旁腺激素水平。所有腺瘤在 C-胆碱 PET/CT 上均表现为示踪剂摄取增加（最大标准化摄取值，5.6±3.0），活性平均为血池的 4.2 倍，甲状腺的 2.1 倍。发现 1 例异位腺瘤。在 6 例经病理证实的病例中，均未见包膜、血管或邻近组织侵犯等高级别特征。另外 3 例 C-胆碱 PET/CT 上疑似甲状旁腺腺瘤的患者最终根据组织诊断发现甲状腺病变；然而，这些患者均无异常钙或甲状旁腺激素水平。
在我们的患者人群中，C-胆碱 PET/CT 对甲状旁腺腺瘤的特异性较高。需要前瞻性研究来验证这一结果，并阐明 C-胆碱 PET/CT 相对于其他方式的效用。
