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. 2023 Jul-Sep;38(3):208-217.
doi: 10.4103/ijnm.ijnm_28_22. Epub 2023 Oct 10.

Comparison of Neck Ultrasonography, Dual Phase 99mTc-Sestamibi with early SPECT-CT & 18F-Fluorocholine PET-CT as First Line Imaging in Patients with Primary Hyperparathyroidism

Behera Abhishek  1 , Ritwik Wakankar  1 , Yamini Dharmashaktu  1 , Nishikant Avinash Damle  1 , Praveen Kumar  1 , Chandrasekhar Bal  1 , Madhavi Tripathi  1 , Devasenathipathy Kandasamy  2 , Rajesh Khadgawat  3 , Shipra Agarwal  4 , Seenu Vuthaluru  5 , Sunil Chumber  5
Affiliations

Comparison of Neck Ultrasonography, Dual Phase 99mTc-Sestamibi with early SPECT-CT & 18F-Fluorocholine PET-CT as First Line Imaging in Patients with Primary Hyperparathyroidism

Behera Abhishek et al. Indian J Nucl Med. 2023 Jul-Sep.

Abstract

Introduction: Successful surgical treatment for primary hyperparathyroidism requires accurate localization of abnormal parathyroid tissue in terms of location and number. Imaging is important for localizing the parathyroid adenoma, and there has been significant interest in 18F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) for this purpose.

Aim: This study attempted to ascertain the utility of 18F-FCH PET/CT as a first-line investigation in preoperative localization of abnormal parathyroid tissue in primary hyperparathyroidism, in comparison with 99mTc-sestamibi dual-phase scintigraphy with early single-photon emission computed tomography (SPECT)/CT and neck ultrasonography.

Materials and methods: Fifty-five patients with biochemical features of primary hyperparathyroidism were enrolled in this study. They underwent neck ultrasonography, 99mTc-sestamibi dual-phase scintigraphy with early SPECT/CT, and 18F-FCH PET/CT for localization of parathyroid lesions. Thirty-three patients underwent surgical resection of the detected lesions. For two patients, clinical and biochemical follow-up was used as a gold standard.

Results: A total of 40 lesions were resected in the 33 patients who underwent surgery. A further two lesions were localized in two patients with clinical and biochemical follow-up as the gold standard. Of these 42 lesions, 41 were detected in preoperative imaging and 1 lesion was noted intraoperatively and resected. 41/42 lesions were detected by 18F-FCH PET/CT (detection rate: 97.6%), 33/42 by 99mTc-sestamibi dual-phase scintigraphy with early SPECT/CT (detection rate: 78.5%), and 30/42 by neck ultrasonography (detection rate: 71.4%).

Conclusion: Detection rates on 18F-FCH PET/CT were superior to both 99mTc-sestamibi dual-phase scintigraphy with early SPECT/CT and neck ultrasonography in preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism.

Keywords: Fluorocholine; hyperparathyroidism; primary; technetium Tc-99m sestamibi.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
A 14-year-old male with right inferior parathyroid adenoma detected on sestamibi scan images (blue arrow)
Figure 2:
Figure 2:
The same patient as in Figure 1, also showing concordant localization on 18F-FCH PET/CT. PET/CT: Positron emission tomography/computed tomography, FCH: Fluorocholine
Figure 3:
Figure 3:
A 30-year-old female with features suggestive of primary hyperparathyroidism. No parathyroid lesion was localized on sestamibi scan with SPECT/CT. SPECT/CT: Single-photon emission computed tomography/computed tomography
Figure 4:
Figure 4:
The above-mentioned patient [Figure 3] underwent FCH PET/CT. A small soft-tissue density lesion (6 mm × 4 mm) was localized posterior to the right lobe with increased radiotracer uptake. On surgical histopathology, the lesion was proven to be a parathyroid adenoma. PET/CT: Positron emission tomography/computed tomography. FCH: Fluorocholine
See this image and copyright information in PMC

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