Division of Visceral Surgery, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
Thyroid Center, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland.
Endocrine. 2022 Feb;75(2):593-600. doi: 10.1007/s12020-021-02877-w. Epub 2021 Sep 24.
Hyperparathyroidism (HPT) is a common disorder. A cure can only be achieved by removing all diseased glands. It is critical to localize the hyperfunctioning glands exactly to prevent extensive surgical exploration. The number of false negative/inconclusive results in standard imaging techniques is high. We aimed to evaluate the diagnostic accuracy of F-Fluorocholine-PET in combination with contrast-enhanced CT (FCH-PET/CT) and its sensitivity in patients with primary, secondary/tertiary, and familial HPT with negative and/or discordant findings in ultrasound and/or Tc-sestamibi scintigraphy/SPECT/CT.
A total of 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. In this retrospective, single institution study, 69 patients, who have undergone surgery and histopathologic workup, were analyzed. Of the 69 patients included, 60 patients suffered from primary HPT, four from secondary or tertiary HPT, and five from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated.
Sensitivity/positive predictive value (PPV) per lesion was 87.5/98.3% for primary HPT, 75/100% for secondary/tertiary HPT and 25/66.7% for familial HPT. Sensitivity/PPV per patient was 91.5/98.2% for primary HPT, 100/100% for secondary/tertiary HPT and 50/100% for familial HPT. All patients showed normalized serum calcium levels in the postoperative period. The follow-up rate was 97%. Of the patients included in the study, 58 of 60 patients with primary HPT, and four of four patients with secondary/tertiary HPT showed normal calcium and parathyroid hormone (PTH) levels after six months and were cured. Of the patients with familial HPT, four of five patients were cured.
Diagnostic accuracy of F-Fluorocholine-PET/CT for patients with pHPT is excellent. F-Fluorocholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.
甲状旁腺功能亢进症（HPT）是一种常见疾病。只有通过切除所有患病腺体才能治愈。精确定位功能亢进的腺体对于防止广泛的手术探查至关重要。标准影像学技术的假阴性/不确定结果数量较高。我们旨在评估 F-氟胆碱-PET 联合对比增强 CT（FCH-PET/CT）在原发性、继发性/三级和家族性 HPT 患者中的诊断准确性，这些患者在超声和/或 Tc- sestamibi 闪烁扫描/SPECT/CT 中具有阴性和/或不一致的结果。
共 96 例 HPT 患者，常规影像学检查阴性/不确定，行 FCH-PET/CT 检查。在这项回顾性、单机构研究中，对已接受手术和组织病理学检查的 69 例患者进行了分析。69 例患者中，60 例原发性 HPT，4 例继发性或三级 HPT，5 例家族性 HPT。计算了敏感性、阳性预测值和准确性。
原发性 HPT 每病灶的敏感性/阳性预测值（PPV）分别为 87.5%/98.3%，继发性/三级 HPT 为 75/100%，家族性 HPT 为 25/66.7%。原发性 HPT 每位患者的敏感性/PPV 分别为 91.5/98.2%，继发性/三级 HPT 为 100/100%，家族性 HPT 为 50/100%。所有患者术后血清钙水平均正常。随访率为 97%。在研究中纳入的患者中，58 例原发性 HPT 患者中的 60 例和 4 例继发性/三级 HPT 患者中的 4 例在 6 个月后血清钙和甲状旁腺激素（PTH）水平正常，被治愈。家族性 HPT 患者中有 5 例中的 4 例被治愈。
F-氟胆碱-PET/CT 对 pHPT 患者的诊断准确性非常高。F-氟胆碱-PET/CT 是内分泌外科医生优化甲状旁腺功能亢进症患者手术治疗的有价值工具。
