Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Preoperative imaging in primary hyperparathyroidism: Are 11 C-Choline PET/CT and 99m Tc-MIBI/123 Iodide Subtraction SPECT/CT interchangeable or do they supplement each other?

Research output: Contribution to journalJournal articlepeer-review

DOI

  1. Prognostic value of contralateral suppression for remission after surgery in patients with primary aldosteronism

    Research output: Contribution to journalJournal articlepeer-review

  2. Revisiting the role of surgery in the treatment of Graves' disease

    Research output: Contribution to journalReviewpeer-review

  3. Clinical assessment of blood pressure in 60 girls with Turner syndrome compared to 1888 healthy Danish girls

    Research output: Contribution to journalJournal articlepeer-review

  4. Raised mortality in old adults with a history of hyperthyroidism following iodine fortification

    Research output: Contribution to journalJournal articlepeer-review

  1. Cardiac CZT-SPECT: More than left ventricular imaging

    Research output: Contribution to journalEditorialpeer-review

  2. Height and bone mineral content after inhaled corticosteroid use in the first 6 years of life

    Research output: Contribution to journalJournal articlepeer-review

View graph of relations

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 99m Tc-MIBI/123 Iodide using SPECT/CT and planar pinhole imaging (Di-SPECT) has shown high sensitivity, but is challenged by high radiation dose, time consumption and cost. 11 C-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.

Original languageEnglish
JournalClinical Endocrinology
Volume97
Issue number3
Pages (from-to)258-267
Number of pages10
ISSN0300-0664
DOIs
Publication statusPublished - Sep 2022

Bibliographical note

This article is protected by copyright. All rights reserved.

    Research areas

  • Choline, Cohort Studies, Humans, Hyperparathyroidism, Primary/diagnostic imaging, Iodides, Parathyroid Glands/diagnostic imaging, Positron Emission Tomography Computed Tomography/methods, Prospective Studies, Radiopharmaceuticals, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon/methods

ID: 74341965