Institut National des Sciences et Techniques Nucléaires - INSTN, Saclay, France.
Association des Praticiens en Médecine Nucléaire d´Ile de France - APRAMEN, Tenon Hospital, Paris, France.
Q J Nucl Med Mol Imaging. 2023 Jun;67(2):96-113. doi: 10.23736/S1824-4785.23.03513-6. Epub 2023 Mar 30.
During the past decade, F-fluorocholine (FCH) PET/CT has been continuously performed at Tenon Hospital (Paris, France) for the detection of hyperfunctioning parathyroid glands (PT).
A cohort of 401 patients, deliberately referred for HPT since September 2012, has been analyzed. The aim of this real-life retrospective study was to determine the diagnostic utility of FCH in this setting, overall and in subgroups according to the type of hyperparathyroidism (HPT), the context of FCH in the imaging work-up and in the patient's history: initial imaging or persistence or recurrence after previous parathyroidectomy (PTX). The influence of the histologic type of resected PTs, hyperplasia or adenoma, on the preoperatory detection on FCH PET/CT has been studied as well.
Four hundred one FCH PET/CTs were included in the cohort, performed in 323 patients with primary HPT (pHPT), including 18 with familial HPT (fHPT), and in 78 patients with secondary renal HPT (rHPT). The overall positivity rate in the 401 FCH PET/CTs was 73%. The PTX rate was twice greater in patients whose FCH PET/CT was positive than negative (73% vs. 35%). Abnormal PT(s) were pathology proven in 214 patients: only hyperplastic gland(s) in 75 cases and at least one adenoma in 136 cases; FCH PET/CT sensitivity was 89% and 92%, respectively. Similarly, there was no significant difference in patient-based sensitivity whether FCH PET/CT was performed as 1 line or later in the imaging work-up, or indicated for initial imaging or for suspicion of persistent or recurrent HPT. Gland-based sensitivity was significantly lower for hyperplasia than for adenoma (72% and 86%, respectively). The lowest gland-based sensitivity value was 65%, observed in case of hyperplasia and when FCH was performed late in the imaging work-up. FCH PET/CT correctly showed multiglandular HPT (MGD) in 36/61 proven cases, 59%. Results of ultrasonography (US) and Tc-sestaMIBI (MIBI) imaging were available in 346 and 178 patients, respectively. For both modalities, the corresponding sensitivity values were significantly less than those of FCH PET/CT (e.g., overall gland-based sensitivity 78% for FCH, 45% for US, 30% for MIBI) and MGD was detected in 32% of cases by US and 15% by MIBI.
Although FCH PET/CT has been performed since 2017 as 1 line imaging for HPT at Tenon Hospital (Paris, France), a large majority of patients underwent prior US and/or MIBI in their preoperative work-up. Therefore, a selection bias is very likely, as most patients referred to FCH PET/CT had non-conclusive or discordant results of US and MIBI, explaining the low performance of those modalities in the present cohort compared to published results. Nevertheless, the superiority of FCH PET/CT over US and MIBI in detecting abnormal PTs reported in various comparative studies is definitely confirmed in this larger real-life cohort. The detection with FCH PET/CT of hyperplastic PTs was somewhat lower than that of adenomas but was better than using US or MIBI. The present results lead to recommend FCH PET/CT as the first line imaging modality in HPT when it is widely available or, if less available, at least in HPT with predominance of hyperplasia and/or MGD.
在过去的十年中，法国巴黎泰诺医院一直在进行 F-氟胆碱（FCH）PET/CT，用于检测功能亢进的甲状旁腺（PT）。
对 401 名患者进行了回顾性分析，这些患者于 2012 年 9 月以来因 HPT 被特意转诊。本研究的目的是确定 FCH 在这种情况下的诊断效用，包括根据 HPT 的类型（原发性 HPT [pHPT]、家族性 HPT [fHPT]、继发性肾性 HPT [rHPT]）、FCH 在影像学检查中的应用情况以及患者病史（初始影像学检查或甲状旁腺切除术 [PTX] 后的持续或复发）进行的分组。还研究了切除的 PT 组织学类型（增生或腺瘤）对 FCH PET/CT 术前检测的影响。
该队列共纳入 401 例 FCH PET/CT，在 323 例 pHPT 患者中进行，包括 18 例 fHPT 患者，78 例 rHPT 患者。401 例 FCH PET/CT 中，阳性率为 73%。FCH PET/CT 阳性患者的 PTX 率是阴性患者的两倍（73%比 35%）。214 例患者的病理证实存在异常 PT：75 例仅有增生性腺体，136 例至少有一个腺瘤；FCH PET/CT 的敏感性分别为 89%和 92%。同样，FCH PET/CT 作为一线或二线影像学检查，或用于初始影像学检查或怀疑持续或复发 HPT 时，在患者基础上的敏感性是否有差异，无统计学意义。与腺瘤相比，增生的腺体基础敏感性较低（分别为 72%和 86%）。当增生且 FCH 在影像学检查中较晚进行时，腺体基础敏感性最低，为 65%。FCH PET/CT 正确显示了 36/61 例证实的多腺体 HPT（MGD），敏感性为 59%。在 346 例和 178 例患者中分别获得了超声（US）和 Tc-sestaMIBI（MIBI）成像的结果。对于这两种方法，其相应的敏感性值均显著低于 FCH PET/CT（例如，FCH 的总腺体敏感性为 78%，US 为 45%，MIBI 为 30%），US 检测到 32%的病例存在 MGD，MIBI 检测到 15%的病例存在 MGD。
尽管自 2017 年以来，FCH PET/CT 已作为法国巴黎泰诺医院 HPT 的一线影像学检查，但大多数患者在术前检查中均进行了超声和/或 MIBI 检查。因此，很可能存在选择偏倚，因为大多数转至 FCH PET/CT 的患者的超声和 MIBI 检查结果不确定或不一致，这解释了与已发表结果相比，这些方法在本队列中的低性能。然而，在各种比较研究中，FCH PET/CT 在检测异常 PT 方面优于 US 和 MIBI 的优越性在本更大的真实队列中得到了明确证实。FCH PET/CT 对增生性 PT 的检测率略低于腺瘤，但优于 US 或 MIBI。本研究结果建议在 FCH PET/CT 广泛应用时，将其作为 HPT 的一线影像学检查方法，如果不那么普及，则至少在增生性和/或 MGD 为主的 HPT 中应用。
