Comparative Analysis of Diagnostic Efficacy in Primary Hyperparathyroidism: A Comparison Analysis of 11C-Choline PET/CT, Neck Ultrasonography, 99mTc-MIBI Dual-Phase Planar Scintigraphy, and 99mTc-MIBI SPECT/CT Imaging

Abstract

Objective: To compare the diagnostic efficacy of ¹¹C-choline PET/CT, neck ultrasonography, ^99mTc-MIBI dual-phase planar scintigraphy, and ^99mTc-MIBI SPECT/CT imaging in the diagnosis of primary hyperparathyroidism (PHPT). Methods: We conducted a retrospective analysis of 32 patients with PHPT who visited the Nuclear Medicine Department of Jilin University China-Japan Union Hospital between January 2019 and December 2022. All patients underwent ¹¹C-choline PET/CT, neck ultrasonography, ^99mTc-MIBI dual-phase planar scintigraphy, and ^99mTc-MIBI SPECT/CT examinations within two months before surgery. Sensitivity, specificity, positive predictive value, and negative predictive value of each imaging study were compared using postoperative pathology and follow-up results. Diagnostic efficacy was further analyzed using ROC curve analysis. Factors influencing on ^99mTc-MIBI imaging were also investigated. Results: A total of 35 lesions were resected in the 32 patients. The diagnostic sensitivity of ¹¹C-choline PET/CT, neck ultrasonography, ^99mTc-MIBI dual-phase planar scintigraphy, and ^99mTc-MIBI SPECT/CT was 88.2%, 52.9%, 58.8%, and 67.6%, respectively. Specificity was 96.8%, 95.7%, 96.8%, and 95.7%, respectively. Positive predictive values were 90.9%, 81.8%, 86.9%, and 85.2%, respectively, and negative predictive values were 95.7%, 84.9%, 86.7%, and 89.1%, respectively. The areas under the ROC curve (AUC) were 0.925, 0.743, 0.778, and 0.817, respectively. Among them, ¹¹C-choline PET/CT had higher sensitivity and AUC than other imaging studies (p<0.05), while specificity, positive predictive value, and negative predictive value were similar (p>0.05). The positive group in ^99mTc-MIBI SPECT/CT imaging had significantly larger lesion diameters than the negative group (P<0.05), while preoperative blood calcium and PTH showed no statistical differences (P>0.05). Conclusion: ¹¹C-choline PET/CT demonstrates superior preoperative diagnostic efficacy for PHPT compared to neck ultrasonography, ^99mTc-MIBI dual-phase planar scintigraphy, and ^99mTc-MIBI SPECT/CT. Lesion size may be the primary factor affecting the sensitivity of ^99mTc-MIBI imaging.

Keywords: 11C-choline; 99mTc-MIBI; PET; SPECT; neck ultrasonography; primary hyperparathyroidism.

Figure 1

(A) Maximum intensity projection image of ¹¹C-choline showing increased radioactive distribution in the left thyroid lobe (red arrow) and below the left thyroid lobe (blue arrow); (B, C) Fusion imaging of ¹¹C-choline PET/CT showing increased radioactive uptake in the left thyroid lobe nodule (red arrow) and a nodule below the lower pole of the left thyroid lobe (blue arrow); Dual-phase planar imaging with ^99mTc-MIBI showing no increased radioactive foci in the early phase (D) or delayed phase (E); (F) Parathyroid adenoma; (G) Immunohistochemistry for PTH (+); (H) Immunohistochemistry for synaptophysin (syN +); (I) Thyroid papillary carcinoma with infarction.

Figure 2

ROC Curve Analysis of the Diagnostic Efficacy of ¹¹C-choline PET/CT, Neck Ultrasound, ^99mTc-MIBI planar scintigraphy, and ^99mTc-MIBI SPECT/CT.