Pretet Valentin, Rotania Marianela, Helali Mehdi, Ignat Mihaela, Vix Michel, Imperiale Alessio
Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France.
Molecular and Nuclear Medicine, Instituto Oulton, X5000 JJS Cordoba, Argentina.
J Clin Med. 2020 Jun 26;9(6):2005. doi: 10.3390/jcm9062005.
The present retrospective study evaluates the diagnostic value of integrated F-Fluorocholine positron emission tomography/four-dimensional contrast-enhanced computed tomography (F-FCH PET/4D-CT) as second-line imaging in preoperative work-up of primary hyperparathyroidism (pHPT), and compares F-FCH PET with 4D-CT. Patients with pHPT and negative/discordant first-line imaging addressed for integrated F-FCH PET/4D-CT were retrospectively selected. Sensitivity and detection rate (DR%) of F-FCH PET/CT, 4D-CT, and PET/4D-CT were calculated according to the per patient and per lesion analyses, and afterwards compared. Histology associated with a decrease more than 50% of perioperative parathyroid hormone (PTH) blood level was used as a gold standard. Persistent high serum PTH and calcium levels during a 6-month follow-up was considered as presence of pHPT in both operated and non-operated patients. 50 patients (55 glands) were included. 44/50 patients (88%) were surgically treated. On a per patient analysis, sensitivity was 93%, 80%, and 95%, and DR% was 82%, 68%, and 84%, respectively for PET/CT, 4D-CT, and PET/4D-CT. PET/CT was more sensitive than 4D-CT ( = 0.046). PET/4D-CT performed better than 4D-CT ( = 0.013) but was equivalent to PET/CT alone. On a per gland analysis, sensitivity PET/CT, 4D-CT, and PET/4D-CT was 88%, 66%, and 92%, and DR% was 79%, 57%, and 83%, respectively. PET/CT and PET/4D-CT were more sensitive than 4D-CT alone ( = 0.01, < 0.001, respectively). However, PET/CT and PET/4D-CT performed similarly. In conclusion, F-FCH PET provides better identification of hyperfunctioning parathyroids than 4D-CT and the combination of both did not significantly improve diagnostic sensitivity. Further investigations involving larger populations are necessary to define the role of F-FCH PET/4D-CT as a "one-stop shop" second-line imaging in preoperative work-up of pHPT, especially considering the additional patient radiation exposure due to multi-phase CT.
本回顾性研究评估了整合氟胆碱正电子发射断层扫描/四维对比增强计算机断层扫描（F-FCH PET/4D-CT）作为原发性甲状旁腺功能亢进症（pHPT）术前检查二线成像的诊断价值，并比较了F-FCH PET与4D-CT。回顾性选取了接受F-FCH PET/4D-CT检查的pHPT患者，这些患者的一线成像结果为阴性或不一致。根据每位患者和每个病灶的分析计算F-FCH PET/CT、4D-CT和PET/4D-CT的敏感性和检出率（DR%），然后进行比较。将围手术期甲状旁腺激素（PTH）血水平下降超过50%相关的组织学结果作为金标准。在6个月的随访期间，持续的高血清PTH和钙水平被视为手术和未手术患者中存在pHPT。纳入了50例患者（55个腺体）。44/50例患者（88%）接受了手术治疗。在每位患者分析中，PET/CT、4D-CT和PET/4D-CT的敏感性分别为93%、80%和95%，DR%分别为82%、68%和84%。PET/CT比4D-CT更敏感（P = 0.046）。PET/4D-CT的表现优于4D-CT（P = 0.013），但与单独的PET/CT相当。在每个腺体分析中，PET/CT、4D-CT和PET/4D-CT的敏感性分别为88%、66%和92%，DR%分别为79%、57%和83%。PET/CT和PET/4D-CT比单独的4D-CT更敏感（分别为P = 0.01，P < 0.001）。然而，PET/CT和PET/4D-CT的表现相似。总之，F-FCH PET比4D-CT能更好地识别功能亢进的甲状旁腺，两者结合并未显著提高诊断敏感性。有必要进行涉及更大人群的进一步研究，以确定F-FCH PET/4D-CT作为pHPT术前检查“一站式”二线成像的作用，特别是考虑到多期CT会增加患者的辐射暴露。
