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Open AccessArticle

18F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism

1
Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France
2
Molecular and Nuclear Medicine, Instituto Oulton, X5000 JJS Cordoba, Argentina
3
General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 67033 Strasbourg, France
4
Faculty of Medicine, University of Strasbourg, 67033 Strasbourg, France
5
Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS/Unistra, 67033 Strasbourg, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(6), 2005; https://doi.org/10.3390/jcm9062005
Received: 2 June 2020 / Revised: 16 June 2020 / Accepted: 24 June 2020 / Published: 26 June 2020
(This article belongs to the Section Nuclear Medicine & Radiology)
The present retrospective study evaluates the diagnostic value of integrated 18F-Fluorocholine positron emission tomography/four-dimensional contrast-enhanced computed tomography (18F-FCH PET/4D-CT) as second-line imaging in preoperative work-up of primary hyperparathyroidism (pHPT), and compares 18F-FCH PET with 4D-CT. Patients with pHPT and negative/discordant first-line imaging addressed for integrated 18F-FCH PET/4D-CT were retrospectively selected. Sensitivity and detection rate (DR%) of 18F-FCH PET/CT, 4D-CT, and PET/4D-CT were calculated according to the per patient and per lesion analyses, and afterwards compared. Histology associated with a decrease more than 50% of perioperative parathyroid hormone (PTH) blood level was used as a gold standard. Persistent high serum PTH and calcium levels during a 6-month follow-up was considered as presence of pHPT in both operated and non-operated patients. 50 patients (55 glands) were included. 44/50 patients (88%) were surgically treated. On a per patient analysis, sensitivity was 93%, 80%, and 95%, and DR% was 82%, 68%, and 84%, respectively for PET/CT, 4D-CT, and PET/4D-CT. PET/CT was more sensitive than 4D-CT (p = 0.046). PET/4D-CT performed better than 4D-CT (p = 0.013) but was equivalent to PET/CT alone. On a per gland analysis, sensitivity PET/CT, 4D-CT, and PET/4D-CT was 88%, 66%, and 92%, and DR% was 79%, 57%, and 83%, respectively. PET/CT and PET/4D-CT were more sensitive than 4D-CT alone (p = 0.01, p < 0.001, respectively). However, PET/CT and PET/4D-CT performed similarly. In conclusion, 18F-FCH PET provides better identification of hyperfunctioning parathyroids than 4D-CT and the combination of both did not significantly improve diagnostic sensitivity. Further investigations involving larger populations are necessary to define the role of 18F-FCH PET/4D-CT as a “one-stop shop” second-line imaging in preoperative work-up of pHPT, especially considering the additional patient radiation exposure due to multi-phase CT. View Full-Text
Keywords: 18F-Fluorocholine PET; 4D contrast-enhanced CT; primary hyperparathyroidism; parathyroid; adenoma 18F-Fluorocholine PET; 4D contrast-enhanced CT; primary hyperparathyroidism; parathyroid; adenoma
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Pretet, V.; Rotania, M.; Helali, M.; Ignat, M.; Vix, M.; Imperiale, A. 18F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism. J. Clin. Med. 2020, 9, 2005.

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