18F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study

Purpose Primary hyperparathyroidism is a common endocrine disorder which is diagnosed biochemically and for which therapy is surgical. A prerequisite for minimally invasive surgery, which minimizes morbidity and cost, is accurate localization of the involved gland(s). The aim of this study was to evaluate the usefulness of F-18-fluorocholine PET/CT for preoperative localization of hyperfunctioning parathyroid tissue. Methods F-18-Fluorocholine PET/CT and conventional parathyroid scintigraphic imaging consisting of Tc-99m-sestaMIBI SPECT/CT, Tc-99m-sestaMIBI dual-phase imaging and Tc-99m-sestaMIBI/pertechnetate subtraction imaging were performed in 24 patients. The diagnostic performance of the imaging methods was compared against histology as the gold standard and postoperative serum Ca2+ and iPTH values. Results The sensitivity and specificity of F-18-fluorocholine PET/CT were 92 % and 100 %, respectively, in contrast to 49 % and 100 %, 46 % and 100 %, and 44 % and 100 % for Tc-99m-sestaMIBI SPECT/CT, Tc-99m-sestaMIBI/pertechnetate subtraction imaging and Tc-99m-sestaMIBI dual-phase imaging, respectively. Combined conventional scintigraphic imaging had a sensitivity and specificity of 64 % and 100 %, respectively. The performance of F-18-fluorocholine PET/CT was superior particularly in patients with multiple lesions or hyperplasia. Conclusion F-18-Fluorocholine PET/CT appears to be a promising, effective imaging method for localization of hyperfunctioning parathyroid tissue.