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PET/CT bests other imaging options for detecting parathyroid adenoma
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LOS ANGELES — In patients with primary hyperparathyroidism, 18F-fluorocholine PET/CT identified more benign parathyroid tumors than high-resolution ultrasound and 99mTc-MIBI SPECT/CT imaging of the neck, according to results of a comparison study presented at the AACE Annual Scientific and Clinical Congress.
“The diagnosis of primary hyperparathyroidism is easy, as it is based on blood biochemistry,” Franco Grimaldi, MD, chief of the endocrinology and metabolism unit at University Hospital S. Maria della Misericordia in Udine, Italy, told Endocrine Today. “More difficulties arise in the parathyroid localization process. Traditional MIBI scintigraphy and neck ultrasound frequently do not succeed in finding the parathyroid adenoma. Our data confirm that 18F-fluorocholine PET/CT has a higher [sensitivity] than the other methods, and it may represent a new important second-line exam for the exact presurgical localization of parathyroid adenomas.”
Grimaldi and colleagues performed imaging of the neck with each of the three techniques on 30 consecutive adults (26 women) with primary hyperparathyroidism, and they also measured calcium, phosphate, parathyroid hormone and bone alkaline phosphatase levels for each patient.
The researchers considered agreement between two of the three techniques to be a correct result for the presence or absence of a parathyroid adenoma. PET identified a tumor in 73.3% of patients, MIBI-SPECT/CT in 40% and ultrasound in 60%. Agreement in identifying a tumor was 23.3% for PET and MIBI-SPECT/CT, 46.7% for PET and ultrasound, and 30% for MIBI-SPECT/CT and ultrasound. Agreement in absence of a tumor was 10% for PET and MIBI-SPECT/CT, 13.3% for PET and ultrasound, and 26.7% for MIBI-SPECT/CT and ultrasound. Ten of the patients with positive results underwent surgery with one experiencing disease persistent postoperatively. The nine successful cases were identified by PET, whereas MIBI-SPECT/CT identified two and ultrasound identified six. The other patients identified as positive for parathyroid adenoma were awaiting or declined surgery at the time study results were reported, according to researchers. Laboratory test results were not associated with imaging results, although patients with adenomas identified by PET vs. those without had statistically higher bone alkaline phosphatase levels (P = .03).
“Attendees will be very interested in our results and its applicability to daily practice and will certainly inquire whether 18F-fluorocholine PET/CT is available in their own local hospitals,” Grimaldi said. – by Jill Rollet
Reference:
Grimaldi F, et al. Efficacy of 18F-fluorocholine PET/CT, 99mTc-MIBI SPECT/CT and high-resolution neck US in the detection of parathyroid adenomas. Presented at: AACE Annual Scientific and Clinical Congress; April 24-28, 2019; Los Angeles.
Disclosures: The authors report no relevant financial disclosures.