University of Groningen, University Medical Center Groningen, Department of Surgery, Groningen, the Netherlands.
University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands.
Langenbecks Arch Surg. 2023 Apr 20;408(1):155. doi: 10.1007/s00423-023-02893-6.
Accurate preoperative localization is imperative to facilitate a minimally invasive parathyroidectomy (MIP) in primary hyperparathyroidism (pHPT). This study aims to compare the diagnostic value of standard-of-care localization techniques (ultrasound [US] and Technetium (Tc) -sestamibi scintigraphy) to [F-18]-fluorocholine positron emission tomography/magnetic resonance imaging (FCH-PET/MRI) to determine the additional clinical usefulness of PET/MRI in a Canadian cohort.
We conducted a prospective, appropriately powered, study to compare the diagnostic value of -FCH PET/MRI to that of the US and Tc-sestamibi scintigraphy for localization of parathyroid adenomas in a patient with pHPT. The primary outcome was the per-lesion sensitivity and positive predictive value (PPV) of FCH-PET/MRI, US, and Tc-sestamibi scintigraphy. Intraoperative surgeon localization, parathormone levels, and histopathological findings were used as reference standards.
Forty-one patients underwent FCH-PET/MRI of which 36 patients had parathyroidectomy. In these 36 patients, 41 parathyroid lesions were histologically confirmed as adenomas or hyperplastic glands. Per-lesion sensitivity of FCH-PET/MRI was 82.9% and of US and Tc-sestamibi scintigraphy combined at 50.0%, respectively. The sensitivity of FCH-PET/MRI was superior to that of US and Tc-sestamibi scintigraphy (p = 0.002). In the 19 patients in whom both US and Tc-sestamibi scintigraphy were negative, PET/MRI correctly identified the parathyroid adenoma in 13 patients (68%).
FCH-PET/MRI is a highly accurate imaging modality for localization of parathyroid adenomas in a tertiary center in North America. It is a superior functional imaging modality to Tc-sestamibi scintigraphy alone and more sensitive for localization of parathyroid lesions than US and Tc-sestamibi scintigraphy combined. This imaging modality could become the most valuable preoperative localization study given its superior performance in localizing parathyroid adenomas.
准确的术前定位对于原发性甲状旁腺功能亢进症（pHPT）的微创甲状旁腺切除术（MIP）至关重要。本研究旨在比较标准护理定位技术（超声[US]和锝（Tc）-甲氧基异丁基异腈闪烁扫描）与[F-18]-氟胆碱正电子发射断层扫描/磁共振成像（FCH-PET/MRI）在加拿大队列中确定 PET/MRI 的额外临床价值。
我们进行了一项前瞻性、适当加权的研究，比较了 FCH-PET/MRI 与 US 和 Tc-甲氧基异丁基异腈闪烁扫描对 pHPT 患者甲状旁腺瘤定位的诊断价值。主要结局是 FCH-PET/MRI 的病变内灵敏度和阳性预测值（PPV），并与 US 和 Tc-甲氧基异丁基异腈闪烁扫描进行比较。术中外科医生定位、甲状旁腺激素水平和组织病理学发现被用作参考标准。
41 例患者接受了 FCH-PET/MRI 检查，其中 36 例患者接受了甲状旁腺切除术。在这 36 例患者中，41 个甲状旁腺病变经组织学证实为腺瘤或增生性腺体。FCH-PET/MRI 的病变内灵敏度为 82.9%，US 和 Tc-甲氧基异丁基异腈闪烁扫描联合检测的灵敏度为 50.0%。FCH-PET/MRI 的灵敏度优于 US 和 Tc-甲氧基异丁基异腈闪烁扫描（p=0.002）。在 US 和 Tc-甲氧基异丁基异腈闪烁扫描均为阴性的 19 例患者中，PET/MRI 正确识别出甲状旁腺腺瘤 13 例（68%）。
FCH-PET/MRI 是北美三级中心甲状旁腺腺瘤定位的一种高度准确的成像方式。它是一种优于 Tc-甲氧基异丁基异腈闪烁扫描的功能成像方式，比 US 和 Tc-甲氧基异丁基异腈闪烁扫描联合检测更敏感地定位甲状旁腺病变。鉴于其在定位甲状旁腺腺瘤方面的卓越性能，该成像方式可能成为最有价值的术前定位研究。
