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. 2025 Mar 23;15(1):10018.
doi: 10.1038/s41598-025-94735-2.

Contribution of 18 F-fluorocholine PET-CT to the preoperative localisation of parathyroid adenoma for the treatment of primary hyperparathyroidism

Suzanne Garnier  1 , Clémentine Mahéo  2 , Gael Potard  2 , Marie-Béatrice Cavarec  3 , Nathalie Roudaut  4 , Philippe Thuillier  4 , Rémi Marianowski  2 , Ronan Abgral  3 , Jean-Christophe Leclere  2
Affiliations

Contribution of 18 F-fluorocholine PET-CT to the preoperative localisation of parathyroid adenoma for the treatment of primary hyperparathyroidism

Suzanne Garnier et al. Sci Rep. .

Abstract

18 F-fluorocholine PET-CT is considered a second-line method for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism. The aim was to compare the diagnostic performance of 18 F-fluorocholine PET-CT and standard imaging modalities in the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism. The primary objective was to assess the performance of 18 F-fluorocholine PET-CT in cases of negative or discordant standard imaging. The secondary objective was to evaluate the diagnostic performance of both 18 F-fluorocholine PET-CT and standard imaging in relation to patient characteristics. We conducted a retrospective, monocentric study, including 156 patients who underwent parathyroidectomy between 2017 and 2023. All patients underwent preoperative 18 F-fluorocholine PET-CT and had an indication for surgery due to primary hyperparathyroidism. A total of 156 patients were included in the study, the majority of whom were women (78%). Seven patients had multigland disease (4.49%). Sensitivity was 60.14% for cervical ultrasound, 46.21% for [99mTc]-MIBI scintigraphy, and 95.97% for 18 F-Fluorocholine PET-CT. 18 F-Fluorocholine PET-CT showed a higher sensitivity than cervical ultrasound and [99mTc]-MIBI scintigraphy, especially for multiple parathyroid adenomas (100, 57.14, and 42.86%, respectively). Univariate analysis showed better results for cervical ultrasound in men (p = 0.005). Larger adenomas showed better performance on [99mTc]-MIBI scintigraphy (p = 0.026), and elevated PTH levels were associated with significantly worse performance on 18 F-fluorocholine PET-CT (p = 0.023). Multivariate analysis showed that scintigraphy performance was worse in the presence of thyroid nodules (p = 0.049, RR = 2.046, 95% CI 1.005-4.166). 18 F-fluorocholine PET-CT is a valuable imaging modality for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism, with superior performance compared to conventional imaging modalities. [99mTc]-MIBI scintigraphy showed reduced diagnostic performance in the presence of thyroid nodules.

Keywords: 18F-Fluorocholine PET-CT; Parathyroid adenoma; Parathyroid scintigraphy.; Primary hyperparathyroidism.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

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