Dekorsy Franziska J, Beyer Leonie, Spitzweg Christine, Schmidmaier Ralf, Todica Andrei, Trupka Arnold, Cyran Clemens C, Berger Frank, Ladurner Roland, Zimmermann Petra, Knösel Thomas, Bartenstein Peter, Lottspeich Christian, Wenter Vera
Department of Nuclear Medicine, University Hospital, LMU Munich, 81377 Munich, Germany.
Department of Internal Medicine IV, University Hospital, LMU Munich, 81377 Munich, Germany.
J Clin Med. 2022 May 23;11(10):2944. doi: 10.3390/jcm11102944.
Primary hyperparathyroidism (pHPT) is a common endocrine disorder due to hyperfunctioning parathyroid glands. To date, the only curing therapy is surgical removal of the dysfunctional gland, making correct detection and localization crucial in order to perform a minimally invasive parathyroidectomy. F-Fluorocholine positron emission tomography/computed tomography (F-FCH PET/CT) has shown promising results for the detection of pHPT, suggesting superiority over conventional imaging with ultrasounds or scintigraphy. A total of 33 patients with pHPT who had negative or equivocal findings in conventional imaging received F-FCH PET/CT preoperatively and were retrospectively included. A pathological hyperfunctional parathyroid gland was diagnosed in 24 cases (positive PET, 72.7%), 4 cases showed equivocal choline uptake (equivocal PET, 12.1%), and in 5 cases, no enhanced choline uptake was evident (negative PET, 15.2%). Twelve of the twenty-four detected adenoma patients underwent surgery, and in all cases, a pathological parathyroid adenoma was resected at the site detected by PET/CT. Two of the six patients without pathological choline uptake who received a parathyroidectomy revealed no evidence of parathyroid adenoma tissue in the histopathological evaluation. This retrospective study analyzes F-FCH PET/CT in a challenging patient cohort with pHPT and negative or equivocal conventional imaging results and supports the use of F-FCH for the diagnosis of hyperfunctional parathyroid tissue, especially in this patient setting, with a 100% true positive and true negative detection rate. Our study further demonstrates the importance of F-FCH PET/CT for successful surgical guidance.
原发性甲状旁腺功能亢进症（pHPT）是一种由于甲状旁腺功能亢进引起的常见内分泌疾病。迄今为止，唯一的治愈性疗法是手术切除功能异常的腺体，因此正确检测和定位对于实施微创甲状旁腺切除术至关重要。F-氟胆碱正电子发射断层扫描/计算机断层扫描（F-FCH PET/CT）在检测pHPT方面已显示出有前景的结果，表明其优于超声或闪烁扫描等传统成像方法。共有33例pHPT患者在传统成像中结果为阴性或不明确，术前接受了F-FCH PET/CT检查，并进行回顾性纳入分析。24例诊断为病理性甲状旁腺功能亢进腺体（PET阳性，72.7%），4例胆碱摄取不明确（PET不明确，12.1%），5例未发现胆碱摄取增强（PET阴性，15.2%）。24例检测到腺瘤的患者中有12例接受了手术，所有病例均在PET/CT检测到的部位切除了病理性甲状旁腺腺瘤。6例未出现病理性胆碱摄取且接受甲状旁腺切除术的患者中有2例在组织病理学评估中未发现甲状旁腺腺瘤组织证据。这项回顾性研究分析了F-FCH PET/CT在具有挑战性的pHPT患者队列中的应用，这些患者传统成像结果为阴性或不明确，支持使用F-FCH诊断甲状旁腺功能亢进组织，尤其是在这种患者情况下，其真阳性和真阴性检测率均为100%。我们的研究进一步证明F-FCH PET/CT对于成功的手术指导的重要性。
