Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy.
Department of Nuclear Medicine and PET/CT Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
Eur J Nucl Med Mol Imaging. 2019 Mar;46(3):766-775. doi: 10.1007/s00259-018-4147-4. Epub 2018 Sep 15.
The localization of hyperfunctioning parathyroid gland(s) (HPTG) in patients with primary hyperparathyroidism (PHPT) with negative or inconclusive first-line imaging is a significant challenge. This study aimed to evaluate the role of integrated F-choline PET/4D contrast-enhanced computed tomography (4DCeCT) in these patients, compare its detection rate and sensitivity with those of F-choline PET/CT and (4DCeCT), and analyse the association between choline metabolism and morphological, biochemical and molecular parameters of HPTG.
We prospectively enrolled 44 PHPT patients with negative or inconclusive first-line imaging. F-Choline PET/CT and 4DCeCT were performed at the same time, and integrated F-choline PET/4DCeCT images were obtained after coregistration. Experienced physicians examined the images. The SUVratio and degree of contrast enhancement were recorded for each positive finding. Histopathology, laboratory and multidisciplinary follow-up were used as the standard of reference. Both the detection rates and sensitivities of the three imaging modalities were calculated retrospectively. Immunohistochemistry was performed to evaluate the molecular profile of HPTGs.
F-Choline PET/4DCeCT was positive in 32 of 44 patients with PHPT (detection rate 72.7%), and 31 of 31 surgically treated patients (sensitivity 100%). These results were significantly (p < 0.05) better than those of F-choline PET/CT (56.8% and 80%, respectively) and those of 4DCeCT (54.5 and 74%, respectively). A significant correlation between SUV and calcium level was found. In a multivariate analysis, only calcium level was significantly associated with F-choline PET/4DCeCT findings. SUVratio and Ki67 expression were significantly correlated.
Integrated F-choline PET/4DCeCT should be considered as an effective tool to detect PHPT in patients with negative or inconclusive first-line imaging. Choline metabolism is correlated with both calcium level and Ki67 expression in HPTG.
对于一线影像学检查结果阴性或不确定的原发性甲状旁腺功能亢进症（PHPT）患者，甲状旁腺功能亢进灶（HPTG）的定位是一项重大挑战。本研究旨在评估整合氟代胆碱 PET/4D 对比增强计算机断层扫描（4DCeCT）在这些患者中的作用，比较其检测率和敏感性与氟代胆碱 PET/CT 和（4DCeCT）的检测率和敏感性，并分析胆碱代谢与 HPTG 的形态、生化和分子参数之间的关系。
我们前瞻性地纳入了 44 例一线影像学检查结果阴性或不确定的 PHPT 患者。同时进行氟代胆碱 PET/CT 和 4DCeCT 检查，并在核心配准后获得整合氟代胆碱 PET/4DCeCT 图像。有经验的医生检查图像。记录每个阳性发现的 SUV 比值和对比增强程度。组织病理学、实验室和多学科随访被用作参考标准。回顾性计算三种成像方式的检测率和敏感度。免疫组织化学用于评估 HPTG 的分子特征。
氟代胆碱 PET/4DCeCT 在 44 例 PHPT 患者中的 32 例（检测率 72.7%）中呈阳性，在 31 例接受手术治疗的患者中（敏感度 100%）中呈阳性。这些结果与氟代胆碱 PET/CT（分别为 56.8%和 80%）和 4DCeCT（分别为 54.5%和 74%）相比，均有显著差异（p<0.05）。SUV 与钙水平之间存在显著相关性。在多变量分析中，只有钙水平与氟代胆碱 PET/4DCeCT 结果显著相关。SUV 比值和 Ki67 表达显著相关。
整合氟代胆碱 PET/4DCeCT 应被视为一种有效的工具，用于检测一线影像学检查结果阴性或不确定的 PHPT 患者。HPTG 中的胆碱代谢与钙水平和 Ki67 表达均相关。
