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Langenbecks Arch Surg. 2016 Nov;401(7):925-935. Epub 2016 Apr 16.

Use of PET tracers for parathyroid localization: a systematic review and meta-analysis.

Author information

1
Department of Surgery, University of California San Francisco, San Francisco, CA, USA. wpkluijfhout@gmail.com.
2
Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands. wpkluijfhout@gmail.com.
3
Department of Surgery, University Health Network, Toronto, ON, Canada.
4
Department of Surgery, University of California San Francisco, San Francisco, CA, USA.
5
Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
6
Department of Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
7
Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
8
Department of Nuclear Medicine, University of California San Francisco, San Francisco, CA, USA.

Abstract

PURPOSE:

The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers.

METHODS:

A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) post-surgical and pathological diagnosis as the gold standard. Performance was expressed in sensitivity and PPV.

RESULTS:

Twenty-four papers were included subdivided by radiopharmaceutical: 14 studies investigated L-[11C]Methionine (11C-MET), one [11C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG), one 6-[18F] fluoro-L-DOPA (18F-DOPA), and three N-[(18F)Fluoromethyl]-2-hydroxy-N,N-dimethylethanaminium (18F-FCH). The 14 studies investigating MET included a total of 327 patients with 364 lesions. Sensitivity for the detection of a lesion in the correct quadrant had a pooled estimate of 69 % (95 % CI 60-78 %). Heterogeneity was overall high with I2 of 51 % (p = 0.01) for all 14 studies. Pooled PPV ranged from 91 to 100 % with a pooled estimate of 98 % (95 % CI 96-100 %). Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance.

CONCLUSIONS:

The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPV and may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.

KEYWORDS:

11C-Methionine; 18F-Fluorocholine; Minimal invasive parathyroidectomy; PET/CT; Primary hyperparathyroidism

PMID:
27086309
PMCID:
PMC5086346
DOI:
10.1007/s00423-016-1425-0
[Indexed for MEDLINE]
Free PMC Article

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