fluorocholine and Adenoma

Primary hyperparathyroidism is characterized by an autonomous hypersecretion of parathyroid hormone by one or more parathyroid glands. Preoperative localization of the affected gland(s) is of key importance in order to allow minimally invasive surgery. At the moment, 11C-Methionine and 18F-Fluorocholine PET studies appear to be among the most promising second-line localization techniques; their comparative diagnostic performance, however, is still unknown.. PubMed/Medline and Embase databases were searched up to October 2020 for studies estimating the diagnostic accuracy of 11C-Methionine PET or 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Pooled sensitivity and positive predictive value were calculated for each tracer on a 'per-lesion' basis and compared using a random-effect model subgroup analysis.. In total, 22Twenty-two studies were finally considered in the meta-analysis. Of these, 8 evaluated the diagnostic accuracy of 11C-Methionine and 14 that of 18F-Fluorocholine. No study directly comparing the two tracers was found. The pooled sensitivity of 18F-Fluorocholine was higher than that of 11C-Methionine (92% vs 80%, P < 0.01), while the positive predictive value was similar (94% vs 95%, P = 0.99). These findings were confirmed in multivariable meta-regression models, demonstrating their apparent independence from other possible predictors or confounders at a study level.. This was the first meta-analysis that specifically compared the diagnostic accuracy of 11C-Methionine and 18F-Fluorocholine PET for parathyroid localization in patients with primary hyperparathyroidism. Our results suggested a superior performance of 18F-Fluorocholine in terms of sensitivity, while the two tracers had comparable accuracy in terms of positive predictive value.

Topics: Adenoma; Carbon Radioisotopes; Choline; Fluorine Radioisotopes; Humans; Hyperparathyroidism, Primary; Methionine; Minimally Invasive Surgical Procedures; Parathyroid Neoplasms; Parathyroidectomy; Positron-Emission Tomography; Preoperative Care

Accurate preoperative localization of parathyroid lesion(s) is crucial for successful surgical management of primary hyperparathyroidism (PHPT). This study was conducted to compare the effectiveness of ultrasonography (USG) of the neck, Tc-sestamibi (MIBI) imaging with or without SPECT/CT, and F-fluorocholine (FCH) PET/CT imaging in the preoperative localization of parathyroid lesions in patients with PHPT.. Fifty-four consecutive patients with PHPT were included in this prospective study who underwent preoperative localization of the parathyroid lesion(s) using 3 diagnostic modalities followed by surgery. The sensitivity, positive predictive value, and accuracy of the 3 imaging procedures to accurately detect abnormal parathyroid glands were determined using histopathology as criterion standard with postoperative biochemical response confirmation.. F-fluorocholine PET/CT detected 52 of 54 patients and 52 of 56 lesions with histopathologically proven parathyroid adenomas on patient-based and lesion-based analysis, respectively. Preoperative USG, MIBI, and FCH PET/CT localized abnormal parathyroid gland(s) in 39 (72.2%), 43 (79.6%), and 54 (100%) patients, respectively. The sensitivity and positive predictive value were 69.3% and 87.1% for USG, 80.7% and 97.6% for MIBI, and 100% and 96.3% for FCH PET/CT. The accuracy was 62.9%, 79.6%, and 96.3% for USG, MIBI, and FCH PET/CT, respectively, in patient-wise analysis. In 6 patients with ectopic lesions, FCH PET/CT demonstrated higher sensitivity and accuracy than MIBI and USG (100% vs 66.6% and 16.7%, respectively).. Among the 3 imaging techniques tested simultaneously, FCH PET/CT was superior for accurate preoperative localization of parathyroid adenomas, especially for ectopic or small parathyroid lesions.

Topics: Adenoma; Adult; Aged; Choline; Female; Humans; Hyperparathyroidism, Primary; Male; Middle Aged; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Postoperative Period; Prospective Studies; Technetium Tc 99m Sestamibi; Ultrasonography; Young Adult

The aim of this study is to determine accurately the localization of the adenoma with the imaging methods in the patients, who are planned to be operated on with prediagnosis of parathyroid adenoma.. In our study, the files of the patients who were considered to have parathyroid adenoma and underwent operation between 2012 and 2020 with the methods such as Tc99m-MIBI SPECT/CT, 18F-fluorocholine PET/CT, and ultrasound, and biochemical examinations were examined retrospectively.. In this study, 31 (18.2%) male and 139 (81.8%) female adult patients were included. The sensitivities of localization methods were 82.6% for ultrasound and 78.4% for scintigraphy. Adenoma was localised in the right place in 14 of 15 (93.3%) patients with the 18F-fluorocholine PET/CT method. A statistically significant correlation was found between the sensitivity of scintigraphy, the gland weights (p: 0.002), and phosphor values (p: 0.039). A statistically significant improvement was observed in the intact PTH value (p: 0.001) 15 min after the removal of adenoma. A statistically significant improvement was observed in the serum PTH value (p: 0.001), the serum phosphorus value (p: 0.001), and the serum calcium (p: 0.001) in the first 3 months after the operation.. Determining localization accurately for the patients enables performing operations with minimally invasive surgery successfully in a shorter time. Also, fewer complications and faster recovery are seen in the patients. It was concluded that studying intraoperative intact PTH and using 18F-fluorocholine PET/CT method for localization give more accurate results for localization and allow having more successful operation outcomes.

Topics: Adenoma; Adult; Female; Humans; Hyperparathyroidism, Primary; Male; Parathyroid Glands; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Retrospective Studies; Technetium Tc 99m Sestamibi; Tomography, Emission-Computed, Single-Photon

Preoperative localization of a parathyroid adenoma is usually obtained by the combination of ultrasound and scintigraphy with technetium-99m methoxyisobutylisonitrile. We evaluated the role of F18-fluorocholine in neck positron emission tomography/magnetic resonance imaging as a novel tool for localizing parathyroid adenomas.. Patients with primary hyperparathyroidism were recruited from February 2016 to August 2017 and F18-fluorocholine positron emission tomography/magnetic resonance imaging was performed to localize the parathyroid adenoma prior to surgery. We compared sensitivity and accuracy of this modality with ultrasound and technetium-99m methoxyisobutylisonitrile scintigraphy using the verified location of the diseased parathyroid as found in surgery.. Nineteen patients were included in our study (15 women and 4 men, mean age 60.5 ± 9.8 years). Positron emission tomography/magnetic resonance imaging precisely localized the pathologic parathyroid gland in 16/19 cases (84.2%) and predicted the diseased side in 19/19 cases (100%). Ultrasound and technetium 99 m methoxyisobutylisonitrile sestamibi scintigraphy predicted the location of the parathyroid adenoma in 16/19 (84.2%) and 14/19 (74%), respectively. In 3/19 patients, positron emission tomography/magnetic resonance imaging localized the parathyroid adenoma where as other modalities failed. Positron emission tomography/magnetic resonance imaging was more accurate when compared to each modality separately (p < 0.001, p = 0.017), however, when comparing the three modalities all together no differences were found (p = 0.506).. Localizing parathyroid adenomas with F18-fluorocholine positron emission tomography/magnetic resonance imaging may be a promising secondary imaging modality.

Topics: Adenoma; Adult; Aged; Choline; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Multimodal Imaging; Parathyroid Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals

To assess the additional diagnostic value of. A retrospective, single-institution study of 26 patients diagnosed with hyperparathyroidism. In cases where ultrasound and scintigraphy failed to detect the location of an adenoma in order to allow a focused surgical approach, an additional. These results demonstrate that. • With

Topics: Adenoma; Aged; Aged, 80 and over; Choline; Female; Fluorine Radioisotopes; Humans; Hyperparathyroidism, Primary; Intraoperative Care; Male; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Physical Examination; Positron Emission Tomography Computed Tomography; Radionuclide Imaging; Radiopharmaceuticals; Reoperation; Retrospective Studies; Ultrasonography

Preoperative localization with Tc-sestaMIBI or ultrasound is a common prerequisite for successful minimally invasive parathyroid adenoma (PA) surgery. SPECT/CT with Tc-sestaMIBI and PET/CT with F-FCH offer the possibility of attenuation correction and coregistration of functional and anatomical images providing more accurate PA localization. F-FCH PET/CT is used predominantly in patients with prostate cancer and is under investigation in PA. We report the case of a 43-year-old man with early FCH uptake in a cystic PA with delayed washout at 60 minutes.

Topics: Adenoma; Adult; Choline; Humans; Male; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Technetium Tc 99m Sestamibi

A 73-year-old man displaying primary hyperparathyroidism with severe hypercalcemia (Ca: 4.1 mmol/l, PTH > 600 pmol/l) was referred for preoperative localization of a parathyroid adenoma. Tc-pertechnetate and Tc-sestaMIBI dual tracer scintigraphy displayed a mild focal uptake in the projection of the right thyroid lobe with negative ultrasonography. F-Fluorocholine PET/CT was quickly performed considering this discrepancy and not only confirmed the scintigraphic findings but also revealed a second contralateral focus of increased uptake, both later confirmed by operative consideration (the two other parathyroid glands are considered normal by the surgeon), pathology, and intraoperative parathyroid hormone assessment.

Topics: Adenoma; Aged; Choline; Humans; Male; Parathyroid Neoplasms; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sestamibi

A 58-old-man underwent (18)F-fluorocholine PET/CT for restaging of prostate cancer because of a rising level of prostate-specific antigen.( 18)F-fluorocholine showed no significant tracer uptake at the site of the prostatectomy or the pelvic lymph nodes. Incidental high tracer uptake was observed in a 26 × 23 mm left thyroid nodule. A benign tumor of the thyroid (oncocytic adenoma of thyroid) was diagnosed after left loboisthmectomy.

Topics: Adenoma; Choline; Humans; Incidental Findings; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Thyroid Neoplasms; Tomography, X-Ray Computed

18F-fluorocholine PET-CT is a new imaging modality for the localization of pathological parathyroid glands in patients with primary hyperparathyroidism. The PET-CT is a combination scan that uses both the physiological information from the PET and the anatomical information from the CT. Uptake of the radio-isotope 18F-fluorocholine is increased in pathological parathyroid glands. 18F-fluorocholine PET-CT helps clinicians to localize the pathological parathyroid glands where conventional modalities fail to do so. This enables surgeons to carry out targeted minimal invasive surgery. It may also prevent the patient having to undergo a more extensive exploration, with its associated risks, and alleviate the necessity of taking medications with side effects. Although the literature on this subject is still scarce, preliminary results are promising. As any hospital with a PET-CT can perform the scan, we expect that its use in patients with hyperparathyroidism will increase over the next few years.

Topics: Adenoma; Choline; Contrast Media; Humans; Hyperparathyroidism, Primary; Parathyroid Neoplasms; Positron-Emission Tomography

Topics: Adenoma; Choline; Humans; Male; Middle Aged; Multimodal Imaging; Neoplasm Staging; Parathyroid Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed

Topics: Adenoma; Aged; Choline; Fluorine Radioisotopes; Humans; Male; Multimodal Imaging; Parathyroid Neoplasms; Positron-Emission Tomography; Tomography, X-Ray Computed

Topics: Adenoma; Adipose Tissue, Brown; Adult; Artifacts; Choline; Diagnosis, Differential; False Positive Reactions; Female; Fluorodeoxyglucose F18; Humans; Liver Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals