在接受[F]氟胆碱PET/CT检查的大量原发性甲状旁腺功能亢进患者中优化术前PET/4D-CT的作用。
Refining the role of presurgical PET/4D-CT in a large series of patients with primary hyperparathyroidism undergoing [F]Fluorocholine PET/CT.
作者信息
Kaseb Ashjan, Benider Houda, Treglia Giorgio, Cusumano Caterina, Bessac Darejan, Trimboli Pierpaolo, Vix Michel, Piccardo Arnoldo, Latgé Adrien, Imperiale Alessio
机构信息
Nuclear Medicine, Institut de Cancérologie de Strasbourg Europe (ICANS), Strasbourg University Hospitals, University of Strasbourg, Strasbourg, France.
Radiology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
出版信息
Eur J Clin Invest. 2025 Feb;55(2):e14336. doi: 10.1111/eci.14336. Epub 2024 Oct 12.
BACKGROUND
4D-CT has garnered attention as complementary imaging for patients with primary hyperparathyroidism (pHPT). Herein we evaluated a diagnostic strategy using [F]Fluorocholine Positron Emission Tomography/Computed Tomography (PET/CT), followed by 4D-CT integrated into PET/4D-CT after negative/inconclusive PET/CT results in a single-center retrospective cohort of 166 pHPT patients who underwent parathyroidectomy after [F]Fluorocholine PET/4D-CT.
METHODS
PET/CT and 4D-CT images were interpreted by three nuclear medicine physicians and one expert radiologist. Pathological findings were documented, and concordance rates were assessed. PET/CT results were categorized as positive/negative, with positive cases rated on a 3-level certitude scale: low, moderate, high. Inconclusive cases included low/moderate positivity. The added value of PET/4D-CT was assessed for negative/inconclusive cases through joint reading.
RESULTS
PET/CT lesion-based analysis showed almost perfect interobserver concordance (Cohen's kappa >.8). Across the cohort, PET/CT had a sensitivity of 83%, specificity of 97%, PPV of 90% and NPV of 94%. For 4D-CT, these values were sensitivity: 53%, specificity: 84%, PPV: 56% and NPV: 82%. PET/CT was significantly more accurate than 4D-CT. Among 44 patients with negative/inconclusive results, PET/CT had sensitivity: 60%, specificity: 91%, PPV: 71% and NPV: 86%. In the same patients, sensitivity and specificity of the sequential diagnostic algorithm increased to 80% and 97%, showing significantly better global accuracy (92% vs. 83%) than standard PET/CT.
CONCLUSIONS
We support a personalized imaging algorithm for pHPT, placing [F]Fluorocholine PET/CT at the forefront, followed by 4D-CT integrated into PET/4D-CT in the same imaging session for negative/inconclusive results. When PET/CT results are clearly positive, the additional sensitivity benefit of 4D-CT is minimal.
背景
4D-CT作为原发性甲状旁腺功能亢进症（pHPT）患者的补充成像技术已受到关注。在此，我们评估了一种诊断策略，即先使用[F]氟胆碱正电子发射断层扫描/计算机断层扫描（PET/CT），对于PET/CT结果为阴性/不确定的情况，再进行4D-CT并将其整合到PET/4D-CT中。该研究为单中心回顾性队列研究，纳入了166例接受[F]氟胆碱PET/4D-CT检查后行甲状旁腺切除术的pHPT患者。
方法
PET/CT和4D-CT图像由三名核医学医师和一名放射科专家解读。记录病理结果并评估一致性率。PET/CT结果分为阳性/阴性，阳性病例按三级确定性量表评分：低、中、高。不确定病例包括低/中度阳性。通过联合读片评估PET/4D-CT对阴性/不确定病例的附加值。
结果
基于PET/CT病变的分析显示观察者间一致性几乎完美（Cohen's kappa>.8）。在整个队列中，PET/CT的敏感性为83%，特异性为97%，阳性预测值为90%，阴性预测值为94%。对于4D-CT，这些值分别为敏感性：53%，特异性：84%，阳性预测值：56%，阴性预测值：82%。PET/CT比4D-CT明显更准确。在44例结果为阴性/不确定的患者中，PET/CT的敏感性为60%，特异性为91%，阳性预测值为71%，阴性预测值为86%。在同一组患者中，序贯诊断算法的敏感性和特异性分别提高到80%和97%，整体准确性（92%对83%）明显优于标准PET/CT。
结论
我们支持针对pHPT的个性化成像算法，将[F]氟胆碱PET/CT置于首位，对于阴性/不确定结果，在同一次成像检查中进行4D-CT并将其整合到PET/4D-CT中。当PET/CT结果明确为阳性时，4D-CT额外的敏感性益处极小。
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