ETA2022 Oral Presentations Oral Session 12: Nodules and Diagnostic (5 abstracts)
Comparison of accuracy of 18F-fluorocholine PET-CT and PET/MR to 99MTC-sestamibi for the localization of hyperfunctioning parathyroid tissue in hyperparathyroidism
Céline Mathey 1 , Vierasu Ortansa-Irina 1 , Keyzer Caroline 2 , Delpierre Isabelle 2 , Trotta Nicola 1 , Julie Absil 2 , Simon Lacroix 1 , Bernard Corvilain 3 , Serge Goldman 1 & Rodrigo Moreno-Reyes 1
1Hub-Erasme University Hospital, Université Libre de Bruxelles, Nuclear Medicine, Brussels, Belgium; 2Hub-Erasme University Hospital, Université Libre de Bruxelles, Medical Imaging, Brussels, Belgium; 3Cliniques Universitaires de Bruxelles – Hôpital Erasme, Hub-Erasme University Hospital, Université Libre de Bruxelles, Endocrinology, Brussels, Belgium
Objectives: The aim of this prospective study was to compare the diagnostic performance of 99mTc-sestaMIBI SPECT scintigraphy (sestaMIBI), 18F-fluorocholine PET/CT or PET/MR (FCH) for preoperative localization of hyperfunctioning parathyroid gland.
Materials and Methods: 60 patients with biochemical evidence of primary (n=57) or tertiary (n=3 kidney transplanted patients) hyperparathyroidism were imaged prospectively with dual phase/dual tracer 99mTc-sestaMIBI SPECT(-CT), early FCH (FCHE) acquired by PET/CT (n=60) and late FCH (FCHL), acquired by PET/CT (n=18) or by PET/MR (n=36). All imaging were interpreted independently by two nuclear medicine physicians and two radiologists. The results were classified into 3 categories (positive, inconclusive or negative) based on the nodular aspect of tracer uptake and the visualization of corresponding nodules on the CT or MRI. The imaging results were confronted to the surgical and histopathological findings and the follow-up.
Results: FCHE was positive in 51/60 (85%) patients, inconclusive in 8 and negative in 1 compared to 48/54 (88,9%), 5 and 1 for FCHL and 41/60 (68%), 13 and 6 for sestaMIBI. FCH (FCHE and FCHL) detected 15 additional positive foci and 18 additional inconclusive foci and it confirmed 19 inconclusive foci. 45 patients underwent surgery and 54 lesions were removed (34 adenomas, 20 hyperplasia and 4 normal glands). FCHE and FCHL PET/CT and PET/MR correctly localised 48 lesions compared to 39 correctly localised by sestaMIBI. Per-lesion sensitivity was 88,88% for FCHE and 87,75% for FCHL – with respectively sensitivity of 100% for acquisition by PET/CT and 82,85% for acquisition by PET/MR – vs 72,22% for sestaMIBI. At follow-up, 34 patients were considered cured after surgery, while 5 patients had a biological recurrence of hypercalcaemia. Biological control is requested for 4 patients and 2 patients are lost to follow-up.
Conclusion: 18F-fluorocholine with PET/CT or PET/MR appears to be superior to sestaMIBI for lesion detection and localization of hyperfunctioning parathyroid tissue, particularly in patients with multiple lesions.
Key words: Hyperparathyroidism; parathyroid adenoma; MIBI SPECT; 18F-fluorocholine; PET/CT; PET/MR.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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