[18F]F-Choline PET/CT and 4D-CT in the evaluation of primary hyperparathyroidism: rivals or allies?

Primary hyperparathyroidism is a hard-to-diagnose condition that can run without symptoms for many years without causing symptoms; yet, it can cause dire long-term consequences, such as osteoporosis and renal impairment. First-line diagnostic methods include ultrasound and para-thyroid scintigraphy, which provide unsatisfactory results in terms of detection rate. Second-line imaging methods include [18F]F-Choline PET/ CT, 4D-CT, and their combination. These methods have shown a great detection rate and sensitivity; however, they are to this day less wide-spread than the first-line ones. Both the two methods (PET and 4D-CT) have their specific advantages and field of application, as well as their specific limitations. In this narrative review, we will describe the advantages and disadvantages of the two techniques extensively. Moreover, we will try to identify whether the combined examination can play a role and how relevant this role is. Finally, we will try to define the specific clinical situation in which each method can provide the best contribution to diagnosing parathyroid tissue hyperfunction.

Automated summary

Primary hyperparathyroidism is a difficult-to-diagnose condition that can remain asymptomatic for many years, causing long-term consequences such as osteoporosis and renal impairment. First-line diagnostic methods like ultrasound and parathyroid scintigraphy have unsatisfactory detection rates. Second-line imaging methods like [18F]F-Choline PET/CT and 4D-CT have shown higher detection rates and sensitivity, but are less commonly used. Both PET and 4D-CT have specific advantages, limitations, and applications. This review extensively describes the pros and cons of these two techniques and explores the potential role of combined examination in diagnosing parathyroid tissue hyperfunction.