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World J Surg. 2019 Jan 18. doi: 10.1007/s00268-019-04910-6. [Epub ahead of print]

18F-Fluorocholine PET/CT and Parathyroid 4D Computed Tomography for Primary Hyperparathyroidism: The Challenge of Reoperative Patients.

Author information

1
Department of Thyroid and Endocrine Tumours, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
2
Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
3
Laboratoire d'imagerie biomedicale (LIB), INSERM U1146, Sorbonne University, Paris, France.
4
Department of Radiology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
5
Laboratory of Endocrine Biochemistry, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
6
Department of Histopathology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
7
Department of Endocrine Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France.
8
Laboratoire d'imagerie fonctionnelle (LIF), INSERM U678, Sorbonne University, Paris, France.
9
Department of Nuclear Medicine, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France. charlotte.lussey@inserm.fr.
10
INSERM, UMR970, Paris-Cardiovascular Research Center, 75015, Paris, France. charlotte.lussey@inserm.fr.

Abstract

BACKGROUND:

To evaluate FCH-PET/CT and parathyroid 4D-CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery.

METHODS:

Medical records of all patients referred for a FCH-PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc-99m-sestaMIBI scintigraphy, and furthermore, some patients had 4D-CT. Gold standard was defined by pathological findings and/or US-guided fine-needle aspiration with PTH level measurement in the washing liquid.

RESULTS:

Twenty-nine patients were included in this retrospective study. FCH-PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D-CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH-PET/CT guidance. US and Tc-99m-sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH-PET/CT foci in 27 patients. On a per-lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH-PET/CT, 75%, 40%, 80% and 33% for 4D-CT. On a per-patient analysis, sensitivity was 85% for FCH-PET/CT and 63% for 4D-CT. FCH-PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc-99m-sestaMIBI scintigraphy result, with a global cure rate of 73%.

CONCLUSION:

FCH-PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D-CT appears as a confirmatory imaging modality.

PMID:
30659347
DOI:
10.1007/s00268-019-04910-6

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