Diagnostic Ability and Correlation of Digital C-Methionine PET/CT in Primary Hyperparathyroidism with Inconclusive Standard Imaging.

PURPOSE

C-Methionine PET/CT is a promising method for detecting parathyroid lesions in patients with primary hyperparathyroidism (PHPT). We aimed to determine the diagnostic ability and correlation of digital C-Methionine PET/CT for parathyroid lesions in patients with PHPT, particularly in cases where standard imaging methods yielded inconclusive results.

METHODS

This retrospective analysis was conducted on patients diagnosed with PHPT who underwent digital C-Methionine PET/CT imaging because of ambiguous results on standard imaging work-up (Tc-MIBI parathyroid scan and/or neck ultrasonography). Quantitative C-Methionine PET/CT parameters, including maximum standardized uptake value (SUVmax), mean SUV (SUVmean), peak SUV (SUVpeak), parathyroid methionine volume (PMV), and whole methionine uptake (WMU: PMV multiplied by SUVmean) were calculated with various thresholds, and their correlations with biochemical and pathologic parameters were investigated.

RESULTS

This study included 22 consecutive patients (10 men and 12 women) with a median age of 64.0 years. The lesion detection rate and sensitivity of digital C-Methionine PET/CT were 81.8% (18/22) and 100.0% (18/18), respectively. Quantitative analysis revealed that serum PTH ( = 0.490,  = 0.039) and serum calcium ( = 0.583,  = 0.011) were significantly correlated with PMV50%.

CONCLUSION

Digital C-Methionine PET/CT offers good performance in the detection of parathyroid lesions in PHPT patients with inconclusive standard imaging work-up. The volume parameter of PMV50% significantly correlated biochemical parameters and can serve as a complementary diagnostic tool.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s13139-024-00878-x.