Results of F-choline and C-methionine positron emission tomography/computed tomography for the preoperative localization of hyperfunctional parathyroid glands in primary hyperparathyroidism.

BACKGROUND

Preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism is essential for successful parathyroid surgery, particularly in patients with previous negative imaging or reoperations.

METHODS

A multicenter registry study was performed in 776 patients with primary hyperparathyroidism from 53 hospitals in Germany and Austria who underwent parathyroid surgery after preoperative F-choline or C-methionine positron emission tomography/computed tomography (PET/CT).

RESULTS

In 683 of 776 patients (88%) (78% female, aged 15-86 years), primary hyperparathyroidism was caused by a single-gland parathyroid adenoma. A total of 9.2% patients had multiglandular disease, 0.4% had parathyroid carcinoma, and, in 2.4%, no hyperfunctional parathyroid glands were found intraoperatively. The sensitivity of F-choline PET/CT was 87.9% compared with 83.2% for C-methionine PET/CT with a positive predictive value for F-choline PET/CT and C-methionine PET/CT of 88.5% and 85.6%, respectively. A subgroup analysis revealed more positive results for F-choline PET/CT in patients with previous neck surgery (89.0%) than for C-methionine PET/CT (74.2%, P = .0411). Positive PET/CT results significantly reduced surgery times decreasing from 93 minutes (±56.54) to 71 minutes (±43.48, P < .0001). Postoperative normalization of calcium levels was achieved in 729 patients (93.9%). In the case of positive PET/CT findings, 97.2% of the patients were cured (P < .0001).

CONCLUSION

Both PET/CT tracers showed excellent detection rates of hyperfunctioning parathyroid glands in primary hyperparathyroidism, especially in a setting with a high percentage of reoperations and negative sestamibi scans.