Diagnostic Performance of 18F-fluorocholine PET/CT Compared to 99mTc-Sestamibi Scintigraphy in Diagnosis of Parathyroid Adenoma

ORIGINAL ARTICLE
Sahar Mansour, Anwar Alanazi, Arwa Alshammari, Farah Almutairi, Juna Bin Dalilah, Reham Hakami, Safiah Alhumaidan, Shomoukh Khaled, Ola Faden, Abdulrahman Albatly

 
For citation: Mansour S, Alanazi A, Alshammari A, Almutairi F, Dalilah JB, Hakami R, Alhumaidan S, Khaled S, Faden O, Albatly A. Diagnostic Performance of 18F-fluorocholine PET/CT Compared to 99mTc-Sestamibi Scintigraphy in Diagnosis of Parathyroid Adenoma. International Journal of Biomedicine. 2024;14(1):83-87. doi:10.21103/Article14(1)_OA12
 
Originally published March 1, 2024

Abstract: 

Background: In most hyperparathyroidism cases, the disease is related to parathyroid adenoma (PTA). Owing to the inconsistencies of currently approved imaging methods, novel methods for detecting PTA are being evaluated. This study aimed to compare 18F-fluorocholine PET/CT with 99mTc-sestamibi SPECT/CT in identifying PTA in Saudi patients.
Methods and Results: The study included 40 adult patients with PTA diagnosed by histopathological findings. 99mTc-sestamibi SPECT/CT and 18F-fluorocholine PET/CT examinations were performed for each patient, and parathyroid hormone (PTH) levels and histologic findings were recorded. The diagnostic ability of 18F-fluorocholine PET/CT (AUC=0.720; P=0.029) was superior to 99mTc-sestamibi SPECT/CT (AUC=0.623; P=0.214) in identifying PTA. The sensitivity and accuracy of 18F-fluorocholine PET/CT (81.5% and 75%, respectively) were significantly (P<0.05) higher than that of 99mTc-sestamibi SPECT/CT (63% and 62.5%, respectively). 18F-fluorocholine PET/CT findings were correlated significantly (P=0.023) with PTH results.
Conclusion: 18F-fluorocholine PET/CT is a diagnostic imaging method superior to conventional modality 99mTc-sestamibi SPECT/CT in the detection of PTA and, thus, allows for accurate preoperative localization.

Keywords: 
18F-fluorocholine PET/CT • parathyroid adenoma • hyperparathyroidism
References: 
  1. Shaker JL, Wermers RA. The Eucalcemic Patient With Elevated Parathyroid Hormone Levels. J Endocr Soc. 2023 Jan 26;7(4):bvad013. doi: 10.1210/jendso/bvad013. PMID: 36793479; PMCID: PMC9922947.
  2. Gowrishankar SV, Bidaye R, Das T, Majcher V, Fish B, Casey R, Masterson L. Intrathyroidal parathyroid adenomas: Scoping review on clinical presentation, preoperative localization, and surgical treatment. Head Neck. 2023 Mar;45(3):706-720. doi: 10.1002/hed.27287. Epub 2022 Dec 23. PMID: 36563301; PMCID: PMC10108101.
  3. Chorti A, Cheva A, Chatzikyriakidou A, Achilla C, Boulogeorgou K, Despoina K, Milias S, Zarampoukas T, Papavramidis T. Sporadic parathyroid adenoma: an updated review of molecular genetics. Front Endocrinol (Lausanne). 2023 May 8;14:1180211. doi: 10.3389/fendo.2023.1180211. PMID: 37223014; PMCID: PMC10200975.
  4. Whitman J, Allen IE, Bergsland EK, Suh I, Hope TA. Assessment and Comparison of 18F-Fluorocholine PET and 99mTc-Sestamibi Scans in Identifying Parathyroid Adenomas: A Metaanalysis. J Nucl Med. 2021 Sep 1;62(9):1285-1291. doi: 10.2967/jnumed.120.257303. Epub 2021 Jan 15. PMID: 33452040; PMCID: PMC8882892.
  5. Hillyar CR, Rizki H, Begum R, Gupta A, Nagabhushan N, Lee PH, Smith S. A Retrospective Cohort Study of the Utility of Ultrasound, 99mTc-Sestamibi Scintigraphy, and Four-Dimensional Computed Tomography for Pre-Operative Localization of Parathyroid Disease To Facilitate Minimally Invasive Parathyroidectomy. Cureus. 2022 Jan 12;14(1):e21177. doi: 10.7759/cureus.21177. PMID: 35165625; PMCID: PMC8837380.
  6. Grimaldi S, Young J, Kamenicky P, Hartl D, Terroir M, Leboulleux S, Berdelou A, Hadoux J, Hescot S, Remy H, Baudin E, Schlumberger M, Deandreis D. Challenging pre-surgical localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism: the added value of 18F-Fluorocholine PET/CT. Eur J Nucl Med Mol Imaging. 2018 Sep;45(10):1772-1780. doi: 10.1007/s00259-018-4018-z. Epub 2018 Apr 22. PMID: 29680989.
  7. Mathey C, Keyzer C, Blocklet D, Van Simaeys G, Trotta N, Lacroix S, Corvilain B, Goldman S, Moreno-Reyes R. 18F-Fluorocholine PET/CT Is More Sensitive Than 11C-Methionine PET/CT for the Localization of Hyperfunctioning Parathyroid Tissue in Primary Hyperparathyroidism. J Nucl Med. 2022 May;63(5):785-791. doi: 10.2967/jnumed.121.262395. Epub 2021 Aug 19. PMID: 34413141.
  8. Cuderman A, Senica K, Rep S, Hocevar M, Kocjan T, Sever MJ, Zaletel K, Lezaic L. 18F-Fluorocholine PET/CT in Primary Hyperparathyroidism: Superior Diagnostic Performance to Conventional Scintigraphic Imaging for Localization of Hyperfunctioning Parathyroid Glands. J Nucl Med. 2020 Apr;61(4):577-583. doi: 10.2967/jnumed.119.229914. Epub 2019 Sep 27. PMID: 31562221.
  9. Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, Giovanella L. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2019 Mar;46(3):751-765. doi: 10.1007/s00259-018-4123-z. Epub 2018 Aug 9. PMID: 30094461.
  10. Thanseer N, Bhadada SK, Sood A, Mittal BR, Behera A, Gorla AKR, Kalathoorakathu RR, Singh P, Dahiya D, Saikia UN, Rao SD. Comparative Effectiveness of Ultrasonography, 99mTc-Sestamibi, and 18F-Fluorocholine PET/CT in Detecting Parathyroid Adenomas in Patients With Primary Hyperparathyroidism. Clin Nucl Med. 2017 Dec;42(12):e491-e497. doi: 10.1097/RLU.0000000000001845. PMID: 28902729.
  11. Bossert I, Chytiris S, Hodolic M, Croce L, Mansi L, Chiovato L, Mariani G, Trifirò G. PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism. J Endocrinol Invest. 2019 Apr;42(4):419-426. doi: 10.1007/s40618-018-0931-z. Epub 2018 Aug 9. PMID: 30094743.
  12. Amadou C, Bera G, Ezziane M, Chami L, Delbot T, Rouxel A, Leban M, Herve G, Menegaux F, Leenhardt L, Kas A, Trésallet C, Ghander C, Lussey-Lepoutre C. 18F-Fluorocholine PET/CT and Parathyroid 4D Computed Tomography for Primary Hyperparathyroidism: The Challenge of Reoperative Patients. World J Surg. 2019 May;43(5):1232-1242. doi: 10.1007/s00268-019-04910-6. PMID: 30659347.
  13. Boudousq V, Guignard N, Gilly O, Chambert B, Mamou A, Moranne O, Zemmour M, Sharara H, Lallemant B. Diagnostic Performance of Cervical Ultrasound, 99mTc-Sestamibi Scintigraphy, and Contrast-Enhanced 18F-Fluorocholine PET in Primary Hyperparathyroidism. J Nucl Med. 2022 Jul;63(7):1081-1086. doi: 10.2967/jnumed.121.261900. Epub 2021 Dec 2. PMID: 34857659.
  14. Dudoignon D, Delbot T, Cottereau AS, Dechmi A, Bienvenu M, Koumakis E, Cormier C, Gaujoux S, Groussin L, Cochand-Priollet B, Clerc J, Wartski M. 18F-fluorocholine PET/CT and conventional imaging in primary hyperparathyroidism. Diagn Interv Imaging. 2022 May;103(5):258-265. doi: 10.1016/j.diii.2021.12.005. Epub 2022 Jan 14. PMID: 35039246.
  15. Araz M, Soydal Ç, Özkan E, Kir MK, İbiş E, Güllü S, Erdoğan MF, Emral R, Küçük ÖN. The efficacy of fluorine-18-choline PET/CT in comparison with 99mTc-MIBI SPECT/CT in the localization of a hyperfunctioning parathyroid gland in primary hyperparathyroidism. Nucl Med Commun. 2018 Nov;39(11):989-994. doi: 10.1097/MNM.0000000000000899. PMID: 30138157.

Download Article
Received December 17, 2023.
Accepted January 24, 2024.
©2024 International Medical Research and Development Corporation.