TY - JOUR

T1 - Preoperative imaging in primary hyperparathyroidism

T2 - Are 11C-Choline PET/CT and 99mTc-MIBI/123Iodide subtraction SPECT/CT interchangeable or do they supplement each other?

AU - Christensen, Julie W.

AU - Ismail, Afefah

AU - Søndergaard, Susanne B.

AU - Bennedbæk, Finn N.

AU - Nygaard, Birte

AU - Jensen, Lars T.

AU - Trolle, Waldemar

AU - Holst-Hahn, Christoffer

AU - Zerahn, Bo

AU - Kristensen, Bent

AU - Krakauer, Martin

N1 - Publisher Copyright: © 2022 The Authors. Clinical Endocrinology published by John Wiley & Sons Ltd.

PY - 2022

Y1 - 2022

N2 - Objective: Preoperative location of hyperfunctioning parathyroid glands (HPGs) is vital when planning minimally invasive surgery in patients with primary hyperparathyroidism (PHPT). Dual-isotope subtraction scintigraphy with 99mTc-MIBI/123Iodide using SPECT/CT and planar pinhole imaging (Di-SPECT) has shown high sensitivity, but is challenged by high radiation dose, time consumption and cost. 11C-Choline PET/CT (faster with a lower radiation dose) is non-inferior to Di-SPECT. We aim to clarify to what extent the two are interchangeable and how often there are discrepancies. Design: This is a prospective, GCP-controlled cohort study. Patients and Measurements: One hundred patients diagnosed with PHPT were included and underwent both imaging modalities before parathyroidectomy. Clinical implications of differences between imaging findings and negative imaging results were assessed. Surgical findings confirmed by biochemistry and pathology served as reference standard. Results: Among the 90 patients cured by parathyroidectomy, sensitivity was 82% (95% confidence interval [CI]: 74%–88%) and 87% (95% CI: 79%–92%) for Choline PET and Di-SPECT, respectively, p =.88. In seven cases at least one imaging modality found no HPG. Of these, neither modality found any true HPGs and only two were cured by surgery. When a positive finding in one modality was incorrect, the alternative modality was correct in approximately half of the cases. Conclusion: Choline PET and Di-SPECT performed equally well and are both appropriate as first-line imaging modalities for preoperative imaging of PHPT. When the first-line modality fails to locate an HPG, additional preoperative imaging with the alternate modality offers no benefit. However, if parathyroidectomy is unsuccessful, additional imaging with the alternate modality has merit before repeat surgery.

AB - Objective: Preoperative location of hyperfunctioning parathyroid glands (HPGs) is vital when planning minimally invasive surgery in patients with primary hyperparathyroidism (PHPT). Dual-isotope subtraction scintigraphy with 99mTc-MIBI/123Iodide using SPECT/CT and planar pinhole imaging (Di-SPECT) has shown high sensitivity, but is challenged by high radiation dose, time consumption and cost. 11C-Choline PET/CT (faster with a lower radiation dose) is non-inferior to Di-SPECT. We aim to clarify to what extent the two are interchangeable and how often there are discrepancies. Design: This is a prospective, GCP-controlled cohort study. Patients and Measurements: One hundred patients diagnosed with PHPT were included and underwent both imaging modalities before parathyroidectomy. Clinical implications of differences between imaging findings and negative imaging results were assessed. Surgical findings confirmed by biochemistry and pathology served as reference standard. Results: Among the 90 patients cured by parathyroidectomy, sensitivity was 82% (95% confidence interval [CI]: 74%–88%) and 87% (95% CI: 79%–92%) for Choline PET and Di-SPECT, respectively, p =.88. In seven cases at least one imaging modality found no HPG. Of these, neither modality found any true HPGs and only two were cured by surgery. When a positive finding in one modality was incorrect, the alternative modality was correct in approximately half of the cases. Conclusion: Choline PET and Di-SPECT performed equally well and are both appropriate as first-line imaging modalities for preoperative imaging of PHPT. When the first-line modality fails to locate an HPG, additional preoperative imaging with the alternate modality offers no benefit. However, if parathyroidectomy is unsuccessful, additional imaging with the alternate modality has merit before repeat surgery.

KW - C-Choline PET/CT

KW - Tc-MIBI/Iodide subtraction SPECT/CT

KW - hyperparathyroidism

KW - method comparison

KW - parathyroidectomy

KW - preoperative imaging

KW - prospective cohort

U2 - 10.1111/cen.14688

DO - 10.1111/cen.14688

M3 - Journal article

C2 - 35150160

AN - SCOPUS:85125059957

VL - 97

SP - 258

EP - 267

JO - Clinical Endocrinology

JF - Clinical Endocrinology

SN - 0300-0664

IS - 3

ER -