Diagnostic Performance of ^{99 m}Tc-Sestamibi SPECT/CT and ¹⁸F-Choline PET/CT in Locating Hyperfunctioning Parathyroid Glands in Patients with Primary Hyperparathyroidism

Abstract

Objective

This study aimed to assess the diagnostic performance of ^99mTc-sestamibi SPECT/CT and ¹⁸F-choline PET/CT in detecting hyperfunctioning parathyroid glands in patients undergoing surgery for primary hyperparathyroidism (PHPT).

Methods

A retrospective analysis was conducted on patients who underwent PHPT-related surgery between April 2019 and May 2022. The study focused on patients undergoing either ^99mTc-sestamibi SPECT/CT (81 patients) or ¹⁸F-choline PET/CT (33 patients) scans before surgery to pinpoint hyperfunctioning parathyroid gland(s). In the majority of patients, ¹⁸F-choline PET/CT was performed after negative or inconclusive findings on ^99mTc-sestamibi SPECT/CT. Pathohistological reports were utilized as the reference standard for evaluating the accuracy of the imaging findings.

Results

The study encompassed 83 patients (70 females, 84.3 %) with an average age of 57.2 years (24–80 years). The pathohistological analysis identified a total of 98 glands. In a per-lesion analysis, the detection rate of ^99mTc-sestamibi SPECT/CT was 57 % (95 % CI 45.3–68.1), while the detection rate of ¹⁸F-choline PET/CT was 90.3 % (95 % CI 74.3–98.0).

Conclusion

The results of our study showed the significant usefulness of ¹⁸F-choline PET/CT in patients with negative or inconclusive results of ^99mTc-sestamibi SPECT/CT in accurately locating hyperfunctioning parathyroid glands in PHPT patients.

Keywords

primary hyperparathyroidism - 18F-fluorocholine - PET imaging - 99mTc-sestamibi - SPECT

• References

• 1 Silva BC, Cusano NE, Bilezikian JP. Primary hyperparathyroidism. Best Pract Res Clin Endocrinol Metab 2018; 32: 593-607
• 2 Bergenfelz AOJ, Hellman P, Harrison B. et al. Positional statement of the European Society of Endocrine Surgeons (ESES) on modern techniques in pHPT surgery. Langenbecks Arch Surg 2009; 394: 761-764
• 3 Wilhelm SM, Wang TS, Ruan DT. et al. The American Association of Endocrine Surgeons guidelines for definitive management of primary hyperparathyroidism. JAMA Surg 2016; 151: 959-968
• 4 Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg 2011; 253: 585-591
• 5 Frank E, Watson W, Fujimoto S. et al. Surgery versus imaging in non-localizing primary hyperparathyroidism: A cost-effectiveness model. Laryngoscope 2020; 130: E963-E969
• 6 Bergenfelz AOJ, Jansson SKG, Wallin GK. et al. 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
• 7 Greene AB, Butler RS, McIntyre S. et al. National trends in parathyroid surgery from 1998 to 2008: A decade of change. J Am Coll Surg 2009; 209: 332-343
• 8 Fraser WD. Hyperparathyroidism. The Lancet 2009; 374: 145-158
• 9 Morris MA, Saboury B, Ahlman M. et al. Parathyroid imaging: Past, present, and future. Front Endocrinol (Lausanne) 2022; 12: 760419
• 10 Treglia G, Sadeghi R, Schalin-Jäntti C. et al. Detection rate of 99m Tc-MIBI single photon emission computed tomography (SPECT)/CT in preoperative planning for patients with primary hyperparathyroidism: A meta-analysis. Head Neck 2016; 38: E2159-E2172
• 11 Mapelli P, Busnardo E, Magnani P. et al. Incidental finding of parathyroid adenoma with 11C-choline PET/CT. Clin Nucl Med 2012; 37: 593-595
• 12 Quak E, Lheureux S, Reznik Y. et al. F18-choline, a novel PET tracer for parathyroid adenoma?. J Clin Endocrinol Metab 2013; 98: 3111-3112
• 13 Broos WAM, van der Zant FM, Knol RJJ. et al. Choline PET/CT in parathyroid imaging. Nucl Med Commun 2019; 40: 96-105
• 14 Petranović Ovčariček P, Giovanella L, Carrió Gasset I. et al. The EANM practice guidelines for parathyroid imaging. Eur J Nucl Med Mol Imaging 2021; 48: 2801-2822
• 15 Rep S, Hocevar M, Vaupotic J. et al. 18 F-choline PET/CT for parathyroid scintigraphy: Significantly lower radiation exposure of patients in comparison to conventional nuclear medicine imaging approaches. J Radiol Prot 2018; 38: 343-356
• 16 Quak E, Lasne Cardon A, Ciappuccini R. et al. Upfront F18-choline PET/CT versus Tc99m-sestaMIBI SPECT/CT guided surgery in primary hyperparathyroidism: The randomized phase III diagnostic trial APACH2. BMC Endocr Disord 2021; 21: 3
• 17 Lezaic L, Rep S, Sever MJ. et al. 18F-fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: A pilot study. Eur J Nucl Med Mol Imaging 2014; 41: 2083-2089
• 18 Fischli S, Suter-Widmer I, Nguyen BT. et al. The significance of 18F-fluorocholine-PET/CT as localizing imaging technique in patients with primary hyperparathyroidism and negative conventional imaging. Front Endocrinol (Lausanne) 2018; 8: 380
• 19 Quak E, Blanchard D, Houdu B. et al. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: The APACH1 study. Eur J Nucl Med Mol Imaging 2018; 45: 658-666
• 20 Cuderman A, Senica K, Rep S. et al. 18 F-fluorocholine PET/CT in primary hyperparathyroidism: Superior diagnostic performance to conventional scintigraphic imaging for localization of hyperfunctioning parathyroid glands. J Nucl Med 2020; 61: 577-583
• 21 Treglia G, Piccardo A, Imperiale A. et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2019; 46: 751-765
• 22 Michaud L, Balogova S, Burgess A. et al. A pilot comparison of 18 F-fluorocholine PET/CT, ultrasonography and 123 I/99m Tc-sestaMIBI dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: Influence of thyroid anomalies. Medicine (Baltimore) 2015; 94: e1701
• 23 Thanseer N, Bhadada SK, Sood A. et al. Comparative effectiveness of ultrasonography, 99mTc-sestamibi, and 18F-fluorocholine PET/CT in detecting parathyroid adenomas in patients with primary hyperparathyroidism. Clin Nucl Med 2017; 42: e491-e497
• 24 Evangelista L, Ravelli I, Magnani F. et al. 18F-choline PET/CT and PET/MRI in primary and recurrent hyperparathyroidism: A systematic review of the literature. Ann Nucl Med 2020; 34: 601-619
• 25 Wong KK, Fig LM, Gross MD. et al. Parathyroid adenoma localization with 99mTc-sestamibi SPECT/CT: A meta analysis. Nucl Med Commun 2015; 36: 363-375
• 26 Beheshti M, Hehenwarter L, Paymani Z. et al. 18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: A prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging 2018; 45: 1762-1771
• 27 Lenschow C, Wennmann A, Hendricks A. et al. Questionable value of [99mTc]-sestamibi scintigraphy in patients with pHPT and negative ultrasound. Langenbecks Arch Surg 2022; 407: 3661-3669