Superior sensitivity of ¹⁸F-fluorocholine: PET localization in primary hyperparathyroidism.

Abstract

Preoperative parathyroid imaging guides surgeons during parathyroidectomy. This study evaluates the clinical impact of ¹⁸F-fluorocholine positron emission tomography for preoperative parathyroid localization on patients with primary hyperparathyroidism. Patients with primary hyperparathyroidism and indications for parathyroidectomy had simultaneous ¹⁸F-fluorocholine positron emission tomography imaging/magnetic resonance imaging. In patients who underwent subsequent parathyroidectomy, cure was based on lab values at least 6 months after surgery. Location-based sensitivity and specificity of ¹⁸F-fluorocholine positron emission tomography imaging was assessed using 3 anatomic locations (left neck, right neck, and mediastinum), with surgery as the gold standard. In 101 patients, ¹⁸F-fluorocholine positron emission tomography localized at least 1 candidate lesion in 93% of patients overall and in 91% of patients with previously negative imaging, leading to a change in preoperative strategy in 60% of patients. Of 76 patients who underwent parathyroidectomy, 58 (77%) had laboratory data at least 6 months postoperatively, with 55/58 patients (95%) demonstrating cure. ¹⁸F-fluorocholine positron emission tomography successfully guided curative surgery in 48/58 (83%) patients, compared with 20/57 (35%) based on ultrasound and 13/55 (24%) based on sestamibi. In a location-based analysis, sensitivity of ¹⁸F-fluorocholine positron emission tomography (88.9%) outperformed both ultrasound (37.1%) and sestamibi (27.5%), as well as ultrasound and sestamibi combined (47.8%). Long-term results in the first cohort in the United States to use ¹⁸F-fluorocholine positron emission tomography for parathyroid localization confirm its utility in a challenging cohort, with better sensitivity than ultrasound or sestamibi.