Nuclear Medicine and Endocrine Tumors, Gustave Roussy, 94800, Villejuif, France.
Department of Endocrinology, Université Paris Sud, Assistance Publique-Hôpitaux de Paris, Bicetre Hospital and INSERM U1185, 78 rue du Général Leclercq, 94275, Le Kremlin Bicêtre, France.
Eur J Nucl Med Mol Imaging. 2018 Sep;45(10):1772-1780. doi: 10.1007/s00259-018-4018-z. Epub 2018 Apr 22.
To evaluate the added value of F-Fluorocholine (F-FCH) PET/CT in presurgical imaging of patients with primary hyperparathyroidism (HPT) and challenging localization of the hyper-functioning parathyroid glands.
We included 27 consecutive patients with primary HPT (19 F; median age: 58 years), with either (i) non-conclusive pre-surgical localization with mTc-sestaMIBI scintigraphy and neck ultrasonography (US), (ii) recurrence of previously operated HPT, or (iii) familiar HPT with a suspicion of multiple gland disease. Histological findings and resolution of HPT were considered as the gold standard.
F-FCH PET/CT was positive in 24/27 patients. Twenty-one patients underwent surgery with 27 resected lesions (14 adenomas, 11 hyperplastic glands, two hyper-functioning histologically normal glands), with resolution of HPT in 19/21 patients (90%). F-FCH PET/CT localized 22 lesions in 17/21 patients (per patient: sensitivity 81%, positive predictive value (PPV) 94%; per gland: sensitivity 76%, PPV 85%, specificity 91%, negative predictive value (NPV) 86%). F-FCH PET/CT found eight lesions which were undetectable on both mTc-sestaMIBI scintigraphy and US. In patients with a familial HPT and/or a multiple gland disease, sensitivity was 100 and 79% on a per-patient and a per-gland analysis respectively, while NPV was 63%. In six patients with a persistence or recurrence of previously treated HPT, F-FCH PET/CT localized all lesions, both in sporadic and familiar disease.
F-FCH PET/CT is a promising modality in challenging pre-surgical localization of hyper-functioning parathyroid glands, such as inconclusive standard imaging, recurrence after surgery, or suspected multiple gland disease.
评估 F-氟代胆碱（F-FCH）PET/CT 在原发性甲状旁腺功能亢进症（HPT）患者术前影像学检查中对定位功能亢进甲状旁腺的附加价值，这些患者的定位存在挑战。
我们纳入了 27 例连续的原发性 HPT 患者（19 例女性；中位年龄：58 岁），这些患者或（i）术前核素扫描和颈部超声检查（US）定位不明确，或（ii）HPT 术后复发，或（iii）有家族性 HPT 病史且怀疑多腺体疾病。以组织学发现和 HPT 缓解为金标准。
27 例患者中有 24 例 F-FCH PET/CT 阳性。21 例患者接受了手术，共切除了 27 个病灶（14 例腺瘤，11 例增生性腺体，2 例组织学正常但功能亢进的腺体），21 例患者（90%）HPT 得到缓解。F-FCH PET/CT 在 17 例患者（22 个病灶）中定位到了 22 个病灶（患者层面：敏感性 81%，阳性预测值（PPV）94%；腺体层面：敏感性 76%，PPV 85%，特异性 91%，阴性预测值（NPV）86%）。F-FCH PET/CT 发现了 8 个在核素扫描和 US 均无法检测到的病灶。在家族性 HPT 和/或多腺体疾病患者中，患者层面和腺体层面的敏感性分别为 100%和 79%，NPV 为 63%。在 6 例先前治疗过的 HPT 复发或持续存在的患者中，F-FCH PET/CT 定位了所有病灶，无论是散发性还是家族性疾病。
F-FCH PET/CT 是一种很有前途的方法，可用于定位功能亢进甲状旁腺，例如定位不明确的标准影像学检查、手术后复发或怀疑多腺体疾病等情况下的术前定位。
