Category: Calcium/Bone Disorders

EFFICACY OF 18F-FLUOROCHOLINE PET/CT, 99MTC-MIBI SPECT/CT AND HIGH-RESOLUTION NECK US IN THE DETECTION OF PARATHYROID ADENOMAS

Thursday, Apr 25
12:15 PM – 12:30 PM

Objective : To compare the accuracy of 18F-fluorocholine PET/CT (PET) with that of both 99mTc-MIBI SPECT/CT (MIBI) and high-resolution neck US (US) in the preoperative detection of parathyroid adenoma (PA) in patients with primary hyperparathyroidism (PHPT).


Methods : Thirty consecutive outpatients (26 females and 4 males) with PHPT underwent US, MIBI and PET. The finding of an enlarged/hyperfunctioning parathyroid gland at least in 2 out of the 3 imaging techniques was considered a positive result. Among positive patients 10 have already undergone surgery for the removal of parathyroid gland while the others are still waiting or refused the procedure. Normal calcium and PTH blood levels were considered as post-surgical recovery. Calcium, phosphate, PTH and bone alkaline phosphatase (bALP) were measured in all patients.


Results :

The detection rates of PA by different imaging techniques were the following: PET 73.3% (22/30), MIBI 40% (12/30) and US 60% (18/30). Concordant positive results were the following: PET-MIBI 23.3% (7/30), PET-US 46.7% (14/30), MIBI-US 30% (9/30). Concordant negative results were the following: PET-MIBI 10% (3/30), PET-US 13.3% (4/30), MIBI-US 26.7% (8/30). Nine out of 10 patients recovered after surgery, while 1 had disease persistence. PA was detected by PET in all the patients who got well, while MIBI found the PA only in 2 and US in 6 out of 9 patients, respectively.
No difference was observed in calcium, phosphate, PTH and bALP between positive and negative findings both by US and by MIBI. PET positive patients had significantly higher values of bALP than negative ones (34,2± 13,4 vs. 21,2±3,7; P=0.03).


Discussion : Our results confirm a higher PA detection rate by PET than by both MIBI and US. Although only 10 patients have undergone surgery as yet, PET seems to be the best method to identify PA. By means of US a well trained operator may find a high number of PAs as our results have shown. MIBI appears to be the method with the lower reliability in finding PAs. Bone alkaline phosphatase may represent a marker for choosing PET as a first-line imaging technique in PHPT.


Conclusion : 18F-fluorocholine PET/CT can be considered a further imaging technique for the identification of pathologic parathyroid glands in patients with PHPT, particularly when traditional methods miss the goal. The role of bALP in predicting positive PET results should undergo further investigations.

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Franco Grimaldi

MD, Chief, Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy
Udien, Italy

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Elda Kara

Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Silvia Maria Sciannimanico

Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Claudia Cipri

Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Silvia Galasso

Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Maria Carpentieri

Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Giampaolo Vianello

Medical Student
University Hospital S. Maria della Misericordia, Udine, Italy

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Marco Rensi

Nuclear Medicine Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Fernando Di Gregorio

Nuclear Medicine Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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Fabio Vescini

Endocrinology and Metabolism Unit
University Hospital S. Maria della Misericordia, Udine, Italy

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