C-11 Methionine Positron Emission Tomography/Computed Tomography Localizes Parathyroid Adenomas in Primary Hyperparathyroidism

 

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Abstract

In patients with primary hyperparathyroidism (pHPT), positive preoperative localization studies enable to perform a minimally invasive approach for parathyroid surgery. However, current imaging techniques are not always successful. We therefore conducted a study to determine the sensitivity of C-11 methionine positron emission tomography/computed tomography (Met-PET/CT) in localizing parathyroid adenomas in pHPT. Met-PET/CT scans of the neck and mediastinum of 33 patients undergoing parathyroidectomy for primary HPT were compared with intraoperative and histological findings. Primary HPT was caused by a single gland adenoma in 30 patients, while another 3 patients had multiglandular disease. Met-PET/CT scan correctly located a single gland adenoma in 25 out of 30 (83%) patients with pHPT, among them 2 patients with persistent disease, 7 patients with prior neck surgery, and 8 patients with concomitant thyroid nodules. In 3 patients with multiglandular disease, Met-PET/CT showed only one enlarged parathyroid gland in two individuals and was negative in the third patient. Statistical analysis found a significant correlation between true-positive results and the weight (2.42±4.05 g) and diameter (2.0±1.18 cm) of parathyroid adenomas while the subgroup with false negative findings had significantly smaller (0.98±0.54 cm) and lighter (0.5±0.38 g) glands. Sensitivity was 83% for single gland adenomas and 67% for multiglandular disease. Met-PET/CT correctly localized 83% of single gland parathyroid adenomas in patients with pHPT. However, preoperative localization of multiglandular disease due to double adenomas or parathyroid hyperplasia remained difficult.

References

• 1 The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism.  Endocrine Practice. 2005;  11 49-54
  Google Scholar
• 2 Miccoli P, Bendinelli C, Berti P, Vignali E, Pinchera A, Marcocci C. Video-assisted versus conventional parathyroidectomy in primary hyperparathyroidism: a prospective randomized study.  Surgery. 1999;  126 1117-1121
  Google Scholar
• 3 Westerdahl J, Bergenfelz A. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial.  Ann Surg. 2007;  246 976-981
  Google Scholar
• 4 Irvin GL, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome.  World J Surg. 2004;  28 1287-1292
  Google Scholar
• 5 Meyer SK, Zorn M, Frank-Raue K, Büchler MW, Nawroth P, Weber T. Clinical impact of two different intraoperative parathyroid hormone assays in primary and renal hyperparathyroidism.  Eur J Endocrinol. 2009;  160 275-281
  Google Scholar
• 6 Udelsman R. Six hundred fifty-six consecutive explorations for primary hyperparathyroidism.  Ann Surg. 2002;  235 665-670
  Google Scholar
• 7 Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience.  Arch Surg. 2005;  140 472-478
  Google Scholar
• 8 Bergenfelz A, Jansson S, Martenson H, Reihnér E, Wallin G, Kristoffersson A, Lausen I. Scandinavian Quality Register for Thyroid and Parathyroid Surgery: audit of surgery for primary hyperparathyroidism.  Langenbecks Arch Surg. 2007;  392 445-451
  Google Scholar
• 9 Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J, Milas M. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1158 cases.  Ann Surg. 2008;  248 420-428
  Google Scholar
• 10 Judson BL, Shaha AR. Nuclear imaging and minimally invasive surgery in the management of hyperparathyroidism.  J Nucl Med. 2008;  49 1813-1818
  Google Scholar
• 11 Bergenfelz AOJ, Jansson SKG, Wallin GK, Martensson HG, Rasmussen L, Eriksson HLO, Reihnér EIM. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients.  Langenbecks Arch Surg. 2009;  394 851-860
  Google Scholar
• 12 Hindie E, Ugur Ö, Fuster D, O’Doherty M, Grasetto G, Urena P, Kettle A, Gulec SA, Pons F, Rubello D. 2009 EANM parathyroid guidelines.  Eur J Nucl Med Imaging. 2009;  36 1201-1216
  Google Scholar
• 13 Reidel MA, Schilling T, Graf S, Hinz U, Nawroth P, Büchler MW, Weber T. Localization of hyperfunctioning parathyroid glands by selective venous sampling in reoperation for primary or secondary hyperparathyroidism.  Surgery. 2006;  140 907-913
  Google Scholar
• 14 Hellman P, Ahlström H, Bergström M, Sundin A, Langström B, Westerberg G, Juhlin C, Akerström G, Rastad J. Positron emission tomography with 11C-methionine in hyperparathyroidism.  Surgery. 1994;  116 974-981
  Google Scholar
• 15 Sundin A, Johansson C, Hellman P, Bergstrom M, Ahlstrom H, Jacobson GB, Langström B, Rastad J. PET and parathyroid l-[carbon-11]methionine accumulation in hyperparathyroidism.  J Nucl Med. 1996;  37 1766-1770
  Google Scholar
• 16 Beggs AD, Hain SF. Localization of parathyroid adenomas using ¹¹C-methionine positron emission tomography.  Nucl Med Commun. 2005;  26 133-136
  Google Scholar
• 17 Tang BN, Moreno-Reyes R, Blocklet D, Corvilain B, Cappello M, Delpierre I. Accurate pre-operative localization of pathological parathyroid glands using 11C-methionine PET/CT.  Contrast Media Mol Imaging. 2008;  3 157-163
  Google Scholar
• 18 Herrmann K, Takei T, Kanegae K, Shiga T, Buck AK, Altomonte J, Schwaiger M, Schuster T, Nishijima K, Kuge Y, Tamaki N. Clinical value and limitations of [(11)C]-Methionine PET for detection and localization of suspected parathyroid adenomas.  Mol Imaging Biol. 2009;  11 356-363
  Google Scholar
• 19 Otto D, Boerner AR, Hofmann M, Brunkhorst T, Meyer GJ, Petrich T,, Scheumann GF, Knapp WH. Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET.  Eur J Nucl Med Mol Imaging. 2004;  31 1405-1412
  Google Scholar
• 20 Rubello D, Fanti S, Nanni C, Farsad M, Castellucci P, Boschi S,, Franchi R, Mariani G, Fig Lm, Gross MD. 11C-methionine PET/CT in 99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis.  Eur J Nucl Med Mol Imaging. 2006;  33 453-459
  Google Scholar
• 21 Cook GJR, Wong JCH, Smellie WJB, Young AE, Maisey MN, Fogelman I. [11C]Methionine positron emission tomography for patients with persistent or recurrent hyperparathyroidism.  Eur J Endocrinol. 1998;  139 195-197
  Google Scholar
• 22 Hessman O, Stalberg P, Sundin A, Garske U, Rudberg C, Eriksson G, Hellman P, Akerström G. High success rate of parathyroid reoperation may be achieved with improved localization diagnosis.  World J Surg. 2008;  32 774-781
  Google Scholar

Correspondence

Prof. Dr. T. Weber

Department of Surgery

University Hospital Ulm

Steinhoevelstraße 9

89075 Ulm

Germany

Phone: +49 731 500 53610

Fax: +49 731 500 53503

Email: theresia.weber@uniklinik-ulm.de