Casanueva-Eliceiry Sebastián, Manyalich-Blasi Marti, Farré-Melero Arnau, Niñerola-Baizán Aida, Saavedra David, Mora-Porta Mireia, Hanzu Felicia A, Orois Aida, Squarcia Mattia, Rodrigo-Calvo Maite, Tormo-Ratera Marta, Quintero-Martinez Katherine, Fuster-Pelfort David, Vidal-Pérez Oscar, Vidal-Sicart Sergi
Department of Nuclear Medicine, Hospital Clínic Barcelona CDI - IDIBAPS, Spain.
Department of General and Digestive Surgery, Hospital Clínic Barcelona - IDIBAPS, Spain.
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2025 Jul-Aug;44(4):500091. doi: 10.1016/j.remnie.2025.500091. Epub 2025 Feb 5.
To compare the diagnostic accuracy of [F]-Fluorocholine (FCH) PET/CT with conventional [mTc]Tc-MIBI scintigraphy and cervical ultrasound (USG) for the preoperative localization of hyperfunctioning parathyroid tissue (HFPT) in patients with primary hyperparathyroidism (PHPT).
This prospective study included 90 patients diagnosed with PHPT who underwent [F]F-CH PET/CT, [mTc]Tc-MIBI SPECT/CT and Neck USG. The diagnostic accuracy of each imaging modality was assessed using intraoperative findings and histopathological confirmation as the gold standard. The localization accuracy was evaluated based on specific quadrant detection, laterality, and ectopic gland identification. The study also explored the correlation between imaging findings and biochemical parameters, including preoperative and postoperative PTH and calcium levels.
[F]F-CH PET/CT demonstrated superior accuracy in detecting pathological parathyroid glands compared to [Tc]Tc-MIBI SPECT/CT and USG. [¹⁸F]F-CH PET/CT correctly identified 98.9% of patients with pathological glands, with a specific location accuracy of 93.2%, 65.9% and 38.8% for [¹⁸F]F-CH PET/CT, [Tc]Tc-MIBI SPECT/CT and USG, respectively. For ectopic adenomas, FCH PET/CT achieved an accuracy of 100% (4/4), while MIBI and neck ultrasound identified these in 50% (2/4) and 0% (0/4) of cases, respectively. There were two cases of multiglandular disease, [F]F-CH PET/CT and [99mTc]Tc-MIBI each detected one gland in one case (50%) while USG detected none; in the other case, [F]F-CH PET/CT and USG identified both glands (100%), and [99mTc]Tc-MIBI detected none. Significant correlations were observed between SUVmax values from [F]F-CH PET/CT and gland size, weight, and preoperative PTH levels.
[F]F-CH PET/CT outperformed conventional imaging modalities in the preoperative localization of HFPT, particularly in challenging cases such ectopic or multiglandular disease. These findings support its potential as an effective and reliable imaging tool for the management of primary hyperparathyroidism.
比较[F]-氟胆碱（FCH）PET/CT与传统的[锝（Tc）]Tc-MIBI闪烁扫描及颈部超声（USG）对原发性甲状旁腺功能亢进症（PHPT）患者功能亢进甲状旁腺组织（HFPT）术前定位的诊断准确性。
这项前瞻性研究纳入了90例诊断为PHPT的患者，他们接受了[F]F-CH PET/CT、[锝（Tc）]Tc-MIBI SPECT/CT及颈部USG检查。以术中发现及组织病理学确诊作为金标准，评估每种成像方式的诊断准确性。基于特定象限检测、侧别及异位腺体识别来评估定位准确性。该研究还探讨了成像结果与生化参数之间的相关性，包括术前及术后的甲状旁腺激素（PTH）和钙水平。
与[锝（Tc）]Tc-MIBI SPECT/CT及USG相比，[F]F-CH PET/CT在检测病理性甲状旁腺方面显示出更高的准确性。[¹⁸F]F-CH PET/CT正确识别出98.9%的有病理性腺体的患者，[¹⁸F]F-CH PET/CT、[锝（Tc）]Tc-MIBI SPECT/CT及USG的特定位置准确性分别为93.2%、65.9%和38.8%。对于异位腺瘤，FCH PET/CT的准确率达到100%（4/4），而MIBI和颈部超声分别在50%（2/4）和0%（0/4）的病例中识别出异位腺瘤。有2例多腺体疾病，[F]F-CH PET/CT和[99mTc]Tc-MIBI在其中1例中各检测到1个腺体（50%），而USG未检测到；在另一例中，[F]F-CH PET/CT和USG识别出了两个腺体（100%），而[99mTc]Tc-MIBI未检测到。观察到[F]F-CH PET/CT的SUVmax值与腺体大小、重量及术前PTH水平之间存在显著相关性。
在HFPT的术前定位方面，[F]F-CH PET/CT优于传统成像方式，尤其是在诸如异位或多腺体疾病等具有挑战性的病例中。这些发现支持了其作为原发性甲状旁腺功能亢进症管理中一种有效且可靠的成像工具的潜力。
