Abstract
Purpose: We aimed to assess the value of 11C-choline positron emission tomography (PET) in patients with primary hyperparathyroidism (pHPT) with negative or discordant results in methoxyisobutylisonitrile (MIBI) imaging and neck ultrasound. Methods: Eighty-seven patients with pHPT and negative or discordant neck ultrasound and MIBI single photon emission computed tomography/computed tomography (SPECT/CT) were assessed using 11C-choline PET/CT and subsequently received a parathyroidectomy. PET/CT image data were analysed semi-quantitatively using maximum standardised uptake value (SUVmax) and ratios (target to the contralateral thyroid gland and carotid artery). A positive PET/CT was defined as a focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered to be positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT was considered be negative. Results: When dichotomizing the 11C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, 84 of 92 lesions (91.3%) were found to have true-positive uptake versus 8 lesions (8.7%) with false-positive uptake. One lesion showed a false-negative uptake; sensitivity was 98.8%. The corresponding lesioned positive predictive value was 91.3%. The mean SUVmax was 6.15±4.92 in 72 lesions with positive uptake (70 patients); and mean SUVmax was 2.96±2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that11C-choline PET/CT is a promising tool for PTA localisation, in cases in which ultrasound and MIBI imaging yield negative or discordant results.
- Copyright © 2019 by the Society of Nuclear Medicine and Molecular Imaging, Inc.