ECE2023 Poster Presentations Calcium and Bone (83 abstracts)
Usefulness of 18F-Fluorocholine Positron Emission Tomography–Computed Tomography in locating parathyroid adenomas in primary hyperparathyroidism
Sara Mera Carreiro 1 , Blanca Bernaldo Madrid 1 , Laura Avila Anton 1 , Noelia Sánchez-Maroto García 1 , Maglen Meneses Navas 2 , Aida Ortega Candil 2 , Mario Pazos Guerra 1 , Patricia Espinosa De Los Monteros 1 , Fernando Hernández Olmeda 1 , santiago ochagavia camara 3 & Maria Paz de Miguel Novoa 1
1Hospital Universitario Clinico San Carlos, Endocrinology and Nutrition, Madrid, Spain; 2Hospital Universitario Clinico San Carlos, Nuclear Medicine, Madrid, Spain; 3Hospital Universitario Clinico San Carlos, General Surgery, Madrid, Spain
Background: Parathyroidectomy is the only definitive treatment for primary hyperparathyroidism (PHPT). Identifying parathyroid adenomas (PA) before surgery is essential to perform minimally invasive surgery and to achieve higher cure rates.
Methods: Retrospective study of patients with PHTP who underwent 18F-Fluorocholine Positron Emission Tomography- Computed Tomography (18FCH-PET-CT) between 2019 and 2021 at our center due to non-localization of PA or discrepancy in previous imaging studies. Diagnostic accuracy of 18FCH-PET-CT and its concordance with other studies and the gold-standard (surgical location) were evaluated.
Results: 86 patients with 18FCH-PET-CT, 99mcTc methoxyisobutylisonitrile scintigraphy (MIBI) and ultrasound (US) were included for analysis.18FCH-PET-CT was positive in 53 patients(61.6%) and negative or inconclusive in 33(38.4%). Group with positive 18FCH-PET-CT(n=53): 77.3% female; 60 mean age. 86% hypercalcemia, 26.4% lithiasis; 37.1% osteoporosis. Mean serum calcium 11 mg/dl; median PTH 125 pg/ml and mean VitD 29.7 ng/ml. In this group, 28 patients underwent surgery and 25 are on the surgery waiting list (SWL). 18FC-PET-CT 100% match the surgical location allowing minimally invasive surgery in 18 out of 28 patients(64.2%). 5 PA were only located with 18FCH-PET-CT. These PA were smaller, with lower mean serum calcium and lower median PTH than those also located by US and/or MIBI. 9 PA were located with US but not with MIBI; and 5 with MIBI but not with US; in both subgroups localization matched with 18FCH-PET-CT and surgery. There were 6 discordant cases between US and MIBI, 1 US and 5 MIBI matched 18FCH-PET-CT and surgery. In 3 cases the PA was located with MIBI and US therefore 18FCH-PET-CT was not needed. Patients on SWL with positive 18FCH-PET-CT(n=25). 11 PA were only located with 18FCH-PET. 6 PA were located with US but not with MIBI; and 2 with MIBI but not with US; in both subgroups localization matched with 18FCH-PET-CT. There were 6 cases discordant between US and MIBI, 3 US and 3 MIBI matched 18FCH-PET-CT. Group with negative 18FCH-PET-CT(n=33): 69.6% female; 57 mean age. 48% hypercalcemia, 33% lithiasis; 48% osteoporosis. Mean serum calcium 10.3 mg/dl; median PTH 112 pg/ml and mean VitD 35 ng/ml. In this group in 22 patients US and MIBI were also negative.
Conclusions: 18FCH-PET-CT was superior to US and MIBI locating PA, allowing us to perform minimally invasive surgery on our patients. PA identified only with 18FCH-PET-CT were smaller, with lower mean serum calcium and lower median PTH than those also located by US and/or MIBI.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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