Broos Wouter A M, Knol Remco J J, Zant Friso M van der, Schaper Nicolaas C, Wondergem Maurits
Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands.
CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands.
World J Nucl Med. 2022 Aug 16;21(3):192-199. doi: 10.1055/s-0042-1751031. eCollection 2022 Sep.
F-choline positron emission tomography/computed tomography (PET/CT) is an upcoming imaging technique for the localization of hyperfunctioning parathyroid glands. However, F-choline is a nonspecific tracer that also accumulates in malignancies, inflammatory lesions, and several other benign abnormalities. The aim of this study was to determine the occurrence and relevance of incidental findings on F-choline PET/CT for parathyroid localization. F-choline PET/CTs performed in our center for parathyroid localization from 2015 to 2019 were reviewed. Abnormal uptake of F-choline, with or without anatomical substrate on the co-registered low-dose CT and also incidental findings on CT without increased F-choline uptake were recorded. Each finding was correlated with follow-up data from the electronic medical records. A total of 388 F-choline PET/CTs were reviewed, with 247 incidental findings detected in 226 patients (58%): 82 F-choline positive findings with corresponding pathology on CT, 16 without CT substrate, and 149 F-choline negative abnormalities on CT. Malignant lesions were detected in 10/388 patients (2.6%). Of all 98 detected F-choline positive lesions, 15 were malignant (15.3%), concerning 4 metastases and 11 primary malignancies: breast carcinoma ( = 7), lung carcinoma ( = 2), thyroid carcinoma ( = 1), and skin melanoma ( = 1). Clinically relevant incidental findings were observed in a substantial number of patients. In 15.3% of the incidental F-choline positive findings, the lesions were malignant. These data contribute to better knowledge of F-choline distribution, enhance interpretation of F-choline PET/CT, and guide follow-up of incidental findings. Attention should especially be paid to breast lesions in this particular patient group with hyperparathyroidism in which women are typically over-represented.
F-胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）是一种用于定位功能亢进甲状旁腺的新兴成像技术。然而，F-胆碱是一种非特异性示踪剂，也会在恶性肿瘤、炎症性病变和其他一些良性异常中积聚。本研究的目的是确定F-胆碱PET/CT用于甲状旁腺定位时偶然发现的发生率及其相关性。
回顾了2015年至2019年在我们中心进行的用于甲状旁腺定位的F-胆碱PET/CT检查。记录了F-胆碱的异常摄取情况，包括在同机低剂量CT上有无解剖学基础，以及CT上无F-胆碱摄取增加的偶然发现。每项发现均与电子病历中的随访数据相关。
共回顾了388例F-胆碱PET/CT检查，在226例患者（58%）中检测到247项偶然发现：82项F-胆碱阳性发现且CT上有相应病理表现，16项无CT基础，149项CT上F-胆碱阴性异常。10/388例患者（2.6%）检测到恶性病变。在所有98例检测到的F-胆碱阳性病变中，15例为恶性（15.3%），包括4例转移瘤和11例原发性恶性肿瘤：乳腺癌（n = 7）、肺癌（n = 2）、甲状腺癌（n = 1）和皮肤黑色素瘤（n = 1）。
在相当数量的患者中观察到了具有临床意义的偶然发现。在偶然的F-胆碱阳性发现中，15.3%的病变为恶性。这些数据有助于更好地了解F-胆碱的分布，加强对F-胆碱PET/CT的解读，并指导对偶然发现的随访。对于这个甲状旁腺功能亢进的特定患者群体，应特别关注乳腺病变，其中女性通常占比过高。
