Optimal scan time for evaluation of parathyroid adenoma with [18F]-fluorocholine PET/CT

Open access


Background. Parathyroid adenomas, the most common cause of primary hyperparathyroidism, are benign tumours which autonomously produce and secrete parathyroid hormone. [18F]-fluorocholine (FCH), PET marker of cellular proliferation, was recently demonstrated to accumulate in lesions representing enlarged parathyroid tissue; however, the optimal time to perform FCH PET/CT after FCH administration is not known. The aim of this study was to determine the optimal scan time of FCH PET/CT in patients with primary hyperparathyroidism.

Patients and methods. 43 patients with primary hyperparathyroidism were enrolled in this study. A triple-phase PET/CT imaging was performed five minutes, one and two hours after the administration of FCH. Regions of interest (ROI) were placed in lesions representing enlarged parathyroid tissue and thyroid tissue. Standardized uptake value (SUVmean), retention index and lesion contrast for parathyroid and thyroid tissue were calculated.

Results. Accumulation of FCH was higher in lesions representing enlarged parathyroid tissue in comparison to the thyroid tissue with significantly higher SUVmean in the second and in the third phase (p < 0.0001). Average retention index decreased significantly between the first and the second phase and increased significantly between the second and the third phase in lesions representing enlarged parathyroid tissue and decreased significantly over all three phases in thyroid tissue (p< 0.0001). The lesion contrast of lesions representing enlarged parathyroid tissue and thyroid tissue was significantly better in the second and the third phase compared to the first phase (p < 0.05).

Conclusions. According to the results the optimal scan time of FCH PET/CT for localization of lesions representing enlarged parathyroid tissue is one hour after administration of the FCH.

1. Lew JI, Solorzano CC. Surgical management of primary hyperparathyroidism: state of the art. Surg Clin North Am 2009; 89: 1205-25.

2. Wada Y, Kunimura T, Sato S, Hisayuki T, Sato M, Imataka H, et al. Proliferating potential and apoptosis in the development of secondary hyperparathyroidism: a study based on Ki-67 immunohistochemical staining and the terminal dUTP nick-end labeling assay. Ther Apher Dial 2008; 12: 319-28.

3. Yamaguchi S, Yachiku S, Morikawa M. Analysis of proliferative activity of the parathyroid glands using proliferating cell nuclear antigen in patients with hyperparathyroidism. J Clin Endocrinol Metab 1997; 82: 2681-8.

4. Allendorf J, DiGorgi M, Spanknebel K, Inabnet W, Chabot J, Logerfo P. 1112 consecutive bilateral neck explorations for primary hyperparathyroidism. World J Surg 2007; 31: 2075-80.

5. Dowthwaite SA, Young JE, Pasternak JD, Yoo J. Surgical management of primary hyperparathyroidism. J Clin Densitom 2013; 16: 48-53.

6. Wang CA. Surgical management of primary hyperparathyroidism. Curr Probl Surg 1985; 22: 1-50.

7. Ruda JM, Hollenbeak CS, Stack BC, Jr. A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003. Otolaryngol Head Neck Surg 2005; 132: 359-72.

8. Miccoli P, Pinchera A, Cecchini G, Conte M, Bendinelli C, Vignali E, et al. Minimally invasive, video-assisted parathyroid surgery for primary hyperparathyroidism. J Endocrinol Invest 1997; 20: 429-30.

9. Goldstein RE, Blevins L, Delbeke D, Martin WH. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg 2000; 231: 732-42.

10. Sosa JA, Udelsman R. Minimally invasive parathyroidectomy. Surg Oncol 2003; 12: 125-34.

11. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 2005; 140: 472-479.

12. Coakley AJ, Kettle AG, Wells CP, O’Doherty MJ, Collins RE. 99mTc sestamibi-a new agent for parathyroid imaging. Nucl Med Commun 1989; 10: 791-4.

13. Borley NR, Collins RE, O’Doherty M, Coakley A. Technetium-99m sestamibi parathyroid localization is accurate enough for scan-directed unilateral neck exploration. Br J Surg 1996; 83: 989-91.

14. Carneiro-Pla DM, Solorzano CC, Irvin GL, 3rd. Consequences of targeted parathyroidectomy guided by localization studies without intraoperative parathyroid hormone monitoring. J Am Coll Surg 2006; 202: 715-22.

15. Lavely WC, Goetze S, Friedman KP, Leal JP, Zhang Z, Garret-Mayer E, et al. Comparison of SPECT/CT, SPECT, and planar imaging with single- and dual-phase (99m)Tc-sestamibi parathyroid scintigraphy. J Nucl Med 2007; 48: 1084-9.

16. Berri RN, Lloyd LR. Detection of parathyroid adenoma in patients with primary hyperparathyroidism: the use of office-based ultrasound in preoperative localization. Am J Surg 2006; 191: 311-4.

17. Haber RS, Kim CK, Inabnet WB. Ultrasonography for preoperative localization of enlarged parathyroid glands in primary hyperparathyroidism: comparison with (99m)technetium sestamibi scintigraphy. Clin Endocrinol (Oxf) 2002; 57: 241-9.

18. Mapelli P, Busnardo E, Magnani P, Freschi M, Picchio M, Gianolli L, et al. Incidental finding of parathyroid adenoma with 11C-choline PET/CT. Clin Nucl Med 2012; 37: 593-5.

19. Quak E, Lheureux S, Reznik Y, Bardet S, Aide N. F18-choline, a novel PET tracer for parathyroid adenoma? J Clin Endocrinol Metab 2013; 98: 3111-2.

20. Lezaic L, Rep S, Jensterle SM, Hocevar M, Fettich J. 18F-fluorocholine PET/CT for localization of hyper functioning parathyroid tissue in primary hyperparathyroidism: a pilot study. Eur J Nucl Med Mol Imaging 2014; 41: 2083-9.

21. Nakayama M, Okizaki A, Ishitoya S, Sakaguchi M, Sato J, Aburano T. Dual-time-point F-18 FDG PET/CT imaging for differentiating the lymph nodes between malignant lymphoma and benign lesions. Ann Nucl Med 2013; 27: 163-9.

22. Cherry SR, Sorenson JA, Phelps ME. Physics in nuclear medicine. 4th edition Philadelphia: Elsevier/Saunders; 2012. p. 253-270.

23. Chien D, Jacene H. Imaging of parathyroid glands. Otolaryngol Clin North Am 2010; 43: 399-415.

24. Hellman P, Ahlström H, Bergström M, Sundin A, Långström B, Westerberg G, et al. Positron emission tomography with 11C-methionine in hyperparathyroidism. Surgery 1994; 116: 974-81.

25. Otto D, Boerner AR, Hofmann M, Brunkhorst T, Meyer GJ, Petrich T, et al. Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET. Eur J Nucl Med Mol Imaging 2004; 31: 1405-12.

26. Oksüz MO, Dittmann H, Wicke C, Müssig K, Bares R, Pfannenberg C, et al. Accuracy of parathyroid imaging: a comparison of planar scintigraphy, SPECT, SPECT/CT, and C-11 methionine PET for the detection of parathyroid adenomas and glandular hyperplasia. Diagn Interv Radiol 2011; 17: 297-307.

27. Giussani A, Janzen T, Uusijarvi-Lizana H, Tavola F, Zankl M, Sydoff M, et al. A compartmental model for biokinetics and dosimetry of 18F-choline in prostate cancer patients. J Nucl Med 2012; 53: 985-93.

28. Tavola F, Janzen T, Giussani A, Facchinetti D, Veronese I, Uusijärvi-Lizana H, et al. Nonlinear compartmental model of 18F-choline. Nucl Med Biol 2012; 39: 261-8.

29. DeGrado TR, Coleman RE, Wang S, Baldwin SW, Orr MD, Robertson CN, et al. Synthesis and evaluation of 18F-labeled choline as an oncologic tracer for positron emission tomography: initial findings in prostate cancer. Cancer Res 2001; 61: 110-7.

Radiology and Oncology

The Journal of Association of Radiology and Oncology

Journal Information

IMPACT FACTOR 2018: 1,846
5-year IMPACT FACTOR: 1,923

CiteScore 2018: 1.94

SCImago Journal Rank (SJR) 2018: 0.651
Source Normalized Impact per Paper (SNIP) 2018: 0.867

Cited By


All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 280 204 23
PDF Downloads 132 107 12