Jacquet-Francillon Nicolas, Morelec Isabelle, Germain Natacha, Prades Jean-Michel, Habouzit Vincent, Mariat Christophe, Bonnefoy Pierre-Benoit, Prevot Nathalie
Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France.
Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France.
Front Med (Lausanne). 2022 Aug 2;9:956580. doi: 10.3389/fmed.2022.956580. eCollection 2022.
[F]Fluorocholine positron emission tomography/computed tomography (PET/CT) is used frequently in addition to [Tc]Tc-Sestamibi scintigraphy and ultrasonography for the location of hyperfunctioning parathyroid glands. The aim of this study is to evaluate the performance of quantitative criteria in [F]fluorocholine PET/CT for localization of hyperfunctioning parathyroid glands. The secondary objective is to highlight a correlation between the detection rate of [F]fluorocholine PET/CT and serum parathyroid hormone (PTH) level.
In two academic centers, we retrospectively included patients with biological hyperparathyroidism (HPT) and who had [F]fluorocholine PET/CT. After a visual analysis, to measure the overall performance of [F]fluorocholine PET/CT, a blind reading was carried out with standardized measurements of maximum standardized uptake value (SUV), liver ratio, thyroid ratio, and size ratio. We analyzed the quantitative criteria of [F]fluorocholine PET/CT compared to the histological results, in particular to identify differences between adenomas and hyperplasias. We compared the performance of each quantitative criterion to the overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [F]fluorocholine PET/CT. The detection rate of hyperfunctioning parathyroid glands was calculated in subgroups of serum PTH level.
The quantitative criteria in [F]fluorocholine PET/CT were measured for 120 patients (135 lesions). The areas under the receiver operating characteristic (ROC) curve representing SUV and liver ratio were significantly increased. The optimal cut-off values represented by the maximum Youden index was >4.12 for SUV and >27.4 for liver ratio. Beyond certain threshold values of SUV (>4.12) or liver ratio (>38.1), all the lesions were histologically proven adenomas. SUV and liver ratio were significantly higher for adenomas than for hyperplasias and differential diagnosis ( = 0.0085 and = 0.0002). The positivity of [F]fluorocholine PET/CT was correlated with PTH level. Detection rates were 55.56, 75.56, and 87.5%, respectively, for serum PTH < 70, 70 to 120, and >120 ng/ml.
Semi-quantitative measurements (SUV and liver ratio) should be considered as additional tools in interpretation of [F]fluorocholine PET/CT. These quantitative parameters have lower overall performance but higher specificity than overall visual analysis in identifying an adenoma. Above certain threshold values, all lesions are adenomas. [F]fluorocholine PET/CT confirms excellent performance for the detection of hyperfunctional parathyroids. For serum PTH levels < 70 ng/ml, the detection rate of [F]fluorocholine PET/CT is strongly decreased.
除了[锝]Tc - 甲氧基异丁基异腈闪烁扫描术和超声检查外，[氟]氟胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）也经常用于定位功能亢进的甲状旁腺。本研究的目的是评估[氟]氟胆碱PET/CT定量标准在定位功能亢进甲状旁腺方面的性能。次要目的是突出[氟]氟胆碱PET/CT的检出率与血清甲状旁腺激素（PTH）水平之间的相关性。
在两个学术中心，我们回顾性纳入了患有生物性甲状旁腺功能亢进（HPT）且接受过[氟]氟胆碱PET/CT检查的患者。在视觉分析之后，为了测量[氟]氟胆碱PET/CT的整体性能，进行了盲法阅读，并对最大标准化摄取值（SUV）、肝脏比值、甲状腺比值和大小比值进行标准化测量。我们将[氟]氟胆碱PET/CT的定量标准与组织学结果进行了分析，特别是为了识别腺瘤和增生之间的差异。我们将每个定量标准的性能与[氟]氟胆碱PET/CT的整体敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性进行了比较。在血清PTH水平的亚组中计算了功能亢进甲状旁腺的检出率。
对120例患者（135个病灶）测量了[氟]氟胆碱PET/CT的定量标准。代表SUV和肝脏比值的受试者操作特征（ROC）曲线下面积显著增加。由最大约登指数表示的最佳截断值，SUV为>4.12，肝脏比值为>27.4。超过SUV（>4.12）或肝脏比值（>38.1）的某些阈值时，所有病灶经组织学证实为腺瘤。腺瘤的SUV和肝脏比值显著高于增生和鉴别诊断（P = 0.0085和P = 0.0002）。[氟]氟胆碱PET/CT的阳性与PTH水平相关。血清PTH<70、70至120和>120 ng/ml时，检出率分别为55.56%、75.56%和87.5%。
在解读[氟]氟胆碱PET/CT时，应将半定量测量（SUV和肝脏比值）视为辅助工具。这些定量参数在识别腺瘤方面整体性能较低，但特异性高于整体视觉分析。超过某些阈值时，所有病灶均为腺瘤。[氟]氟胆碱PET/CT在检测功能亢进的甲状旁腺方面证实具有优异的性能。对于血清PTH水平<70 ng/ml，[氟]氟胆碱PET/CT的检出率会大幅降低。
