Results of ¹⁸F-choline and ¹¹C-methionine positron emission tomography/computed tomography for the preoperative localization of hyperfunctional parathyroid glands in primary hyperparathyroidism.

Abstract

Preoperative localization of hyperfunctioning parathyroid glands in primary hyperparathyroidism is essential for successful parathyroid surgery, particularly in patients with previous negative imaging or reoperations. A multicenter registry study was performed in 776 patients with primary hyperparathyroidism from 53 hospitals in Germany and Austria who underwent parathyroid surgery after preoperative ¹⁸F-choline or ¹¹C-methionine positron emission tomography/computed tomography (PET/CT). In 683 of 776 patients (88%) (78% female, aged 15-86 years), primary hyperparathyroidism was caused by a single-gland parathyroid adenoma. A total of 9.2% patients had multiglandular disease, 0.4% had parathyroid carcinoma, and, in 2.4%, no hyperfunctional parathyroid glands were found intraoperatively. The sensitivity of ¹⁸F-choline PET/CT was 87.9% compared with 83.2% for ¹¹C-methionine PET/CT with a positive predictive value for ¹⁸F-choline PET/CT and ¹¹C-methionine PET/CT of 88.5% and 85.6%, respectively. A subgroup analysis revealed more positive results for ¹⁸F-choline PET/CT in patients with previous neck surgery (89.0%) than for ¹¹C-methionine PET/CT (74.2%, P = .0411). Positive PET/CT results significantly reduced surgery times decreasing from 93 minutes (±56.54) to 71 minutes (±43.48, P < .0001). Postoperative normalization of calcium levels was achieved in 729 patients (93.9%). In the case of positive PET/CT findings, 97.2% of the patients were cured (P < .0001). Both PET/CT tracers showed excellent detection rates of hyperfunctioning parathyroid glands in primary hyperparathyroidism, especially in a setting with a high percentage of reoperations and negative sestamibi scans.