scholarly journals Parathyroid Imaging by 18F-Fluorocholine PET/CT in Patients With Primary Hyperparathyroidism and Inconclusive Conventional Methods: Clinico-Pathological Correlations

2018 ◽  
pp. S551-S557 ◽  
Author(s):  
K. ZAJÍČKOVÁ ◽  
D. ZOGALA ◽  
J. KUBINYI
Keyword(s):  
Primary Hyperparathyroidism ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Parathyroid Adenomas ◽  
Parathyroid Lesions ◽  
Mean Size ◽  
Parathyroid Imaging ◽  
Mibi Scintigraphy

18F-fluorocholine positron emission tomography/computed tomography (FCH) was performed after inconclusive neck ultrasound and 99Tc-sestaMIBI SPECT (MIBI) scintigraphy in patients with primary hyperparathyroidism (PHPT) to localize abnormal parathyroid glands before surgery. The results were retrospectively evaluated and compared to postoperative histopathological findings. 13 patients with PHPT were enrolled (mean age 64.3 years, preoperative calcium 2.74 mmol/l and parathyroid hormone 114.6 ng/l). FCH localized hyperfunctioning parathyroid glands in 12 patients of 13 (per patient sensitivity 92 % and positive predictive value (PPV) 100 %). Fourteen parathyroid lesions (11 adenomas, 3 hyperplastic glands) were resected with a mean size of 11.9 mm (per lesion sensitivity 93 % and PPV 81 %). Four adenomas and one hyperplastic gland were composed of only chief cells, whereas five lesions contained both chief and oxyphil cells. In three patients an exclusively oxyphil adenoma was found, surprisingly with negative MIBI scintigraphy in spite of a high mitochondria content in the oxyphil parathyroid cells. 12 of 13 patients had thyroid disease. In our limited study sample, FCH correctly identified parathyroid adenomas and/or hyperplastic glands in 92 % of patients with previously inconclusive conventional imaging. Unlike MIBI, FCH successfully localized small, hyperplastic and multiple hyperfunctioning parathyroid glands, irrespective of their histopathological composition.

scholarly journals The EANM practice guidelines for parathyroid imaging

2021 ◽  
Author(s):  
Petra Petranović Ovčariček ◽  
Luca Giovanella ◽  
Ignasi Carrió Gasset ◽  
Elif Hindié ◽  
Martin W. Huellner ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Nuclear Medicine ◽  
Minimally Invasive ◽  
Minimally Invasive Parathyroidectomy ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Invasive Parathyroidectomy ◽  
Positron Emission ◽  
Parathyroid Imaging

Abstract Introduction Nuclear medicine parathyroid imaging is important in the identification of hyperfunctioning parathyroid glands in primary hyperparathyroidism (pHPT), but it may be also valuable before surgical treatment in secondary hyperparathyroidism (sHPT). Parathyroid radionuclide imaging with scintigraphy or positron emission tomography (PET) is a highly sensitive procedure for the assessment of the presence and number of hyperfunctioning parathyroid glands, located either at typical sites or ectopically. The treatment of pHPT is mostly directed toward minimally invasive parathyroidectomy, especially in cases with a single adenoma. In experienced hands, successful surgery depends mainly on the exact preoperative localization of one or more hyperfunctioning parathyroid adenomas. Failure to preoperatively identify the hyperfunctioning parathyroid gland challenges minimally invasive parathyroidectomy and might require bilateral open neck exploration. Methods Over a decade has now passed since the European Association of Nuclear Medicine (EANM) issued the first edition of the guideline on parathyroid imaging, and a number of new insights and techniques have been developed since. The aim of the present document is to provide state-of-the-art guidelines for nuclear medicine physicians performing parathyroid scintigraphy, single-photon emission computed tomography/computed tomography (SPECT/CT), positron emission tomography/computed tomography (PET/CT), and positron emission tomography/magnetic resonance imaging (PET/MRI) in patients with pHPT, as well as in those with sHPT. Conclusion These guidelines are written and authorized by the EANM to promote optimal parathyroid imaging. They will assist nuclear medicine physicians in the detection and correct localization of hyperfunctioning parathyroid lesions.

scholarly journals A retrospective analysis of the diagnostic performance of 11C-choline PET/CT for detection of hyperfunctioning parathyroid glands after prior negative or discordant imaging in primary hyperparathyroidism

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. E. Noltes ◽  
S. Kruijff ◽  
L. Jansen ◽  
H. E. Westerlaan ◽  
W. T. Zandee ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Diagnostic Performance ◽  
Histopathological Examination ◽  
Parathyroid Glands ◽  
First Line ◽  
Choline Pet ◽  
Imaging Results ◽  
Pet Ct ◽  
Parathyroid Lesions ◽  
Line Imaging

Abstract Background Identifying the correct location of a parathyroid adenoma in patients with primary hyperparathyroidism (pHPT) is crucial as it can guide surgical treatment. This study aimed to determine the diagnostic performance of 11C-choline PET/CT in patients with pHPT as a next in-line scan after primary negative or discordant first-line imaging. Methods This was a retrospective single-center cohort study. All patients with pHPT that were scanned utilizing 11C-choline PET/CT, after prior negative or discordant imaging, between 2015 and 2019 and who subsequently underwent parathyroid surgery were included. The results of the 11C-choline PET/CT were evaluated lesion-based, with surgical exploration and histopathological examination as the gold standard. Results In total, 36 patients were included of which three patients were known to have Multiple Endocrine Neoplasia (MEN) syndrome. In these 36 patients, 40 lesions were identified on 11C-choline PET/CT and 37 parathyroid lesions were surgically removed. In 34/36 (94%) patients a focused parathyroidectomy was performed, in one patient a cervical exploration due to an ectopically identified adenoma, and in one patient a bilateral exploration was performed because of a double adenoma. Overall, per-lesion sensitivity of 11C-choline PET/CT was 97%, the positive predictive value was 95% and the accuracy was 94% for all parathyroid lesions. Conclusions In patients with pHPT and prior negative or discordant first-line imaging results, pathological parathyroid glands can be localized by 11C-choline PET/CT with high sensitivity and accuracy.

scholarly journals Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: A retrospective review

2017 ◽  
Author(s):  
Fanny Moron ◽  
Alfred Delumpa ◽  
Justin Chetta ◽  
Danielle Guffey ◽  
David Dunaway
Keyword(s):  
Primary Hyperparathyroidism ◽  
Single Phase ◽  
Parathyroid Glands ◽  
Ct Scans ◽  
Arterial Phase ◽  
Phase Method ◽  
Dual Phase ◽  
Parathyroid Adenomas ◽  
Multiphase Ct ◽  
Parathyroid Imaging

Objective: This study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism. Methods: The CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas. Results: The parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p=0.695). These results are similar to those found in the literature for multiphase CT of 55-94%. Conclusions: Our study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: A single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.

scholarly journals Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: A retrospective review

2017 ◽  
Author(s):  
Fanny Moron ◽  
Alfred Delumpa ◽  
Justin Chetta ◽  
Danielle Guffey ◽  
David Dunaway
Keyword(s):  
Primary Hyperparathyroidism ◽  
Single Phase ◽  
Parathyroid Glands ◽  
Ct Scans ◽  
Arterial Phase ◽  
Phase Method ◽  
Dual Phase ◽  
Parathyroid Adenomas ◽  
Multiphase Ct ◽  
Parathyroid Imaging

Objective: This study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism. Methods: The CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas. Results: The parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p=0.695). These results are similar to those found in the literature for multiphase CT of 55-94%. Conclusions: Our study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: A single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.

scholarly journals Single phase computed tomography is equivalent to dual phase method for localizing hyperfunctioning parathyroid glands in patients with primary hyperparathyroidism: a retrospective review

PeerJ ◽  
2017 ◽  
Vol 5 ◽  
pp. e3586 ◽  
Author(s):  
Fanny Morón ◽  
Alfred Delumpa ◽  
Justin Chetta ◽  
Danielle Guffey ◽  
David Dunaway
Keyword(s):  
Primary Hyperparathyroidism ◽  
Single Phase ◽  
Parathyroid Glands ◽  
Ct Scans ◽  
Arterial Phase ◽  
Phase Method ◽  
Dual Phase ◽  
Parathyroid Adenomas ◽  
Multiphase Ct ◽  
Parathyroid Imaging

Objective This study aims to compare the sensitivity of dual phase (non-contrast and arterial) versus single phase (arterial) CT for detection of hyper-functioning parathyroid glands in patients with primary hyperparathyroidism. Methods The CT scans of thirty-two patients who have biochemical evidence of primary hyperparathyroidism, pathologically proven parathyroid adenomas, and pre-operative multiphase parathyroid imaging were evaluated retrospectively in order to compare the adequacy of single phase vs. dual phase CT scans for the detection of parathyroid adenomas. Results The parathyroid adenomas were localized in 83% of cases on single arterial phase CT and 80% of cases on dual phase CT. The specificity for localization of parathyroid tumor was 96% for single phase CT and 97% for dual phase CT. The results were not significantly different (p = 0.695). These results are similar to those found in the literature for multiphase CT of 55–94%. Conclusions Our study supports the use of a single arterial phase CT for the detection of hyperfunctioning parathyroid adenomas. Advances in knowledge: a single arterial phase CT has similar sensitivity for localizing parathyroid adenomas as dual phase CT and significantly reduces radiation dose to the patient.

PET with 18F-DOPA in the imaging of parathyroid adenoma in patients with primary hyperparathyroidism

2006 ◽  
Vol 45 (05) ◽  
pp. 193-196 ◽  
Author(s):  
A. Lange-Nolde ◽  
T. Zajic ◽  
M. Slawik ◽  
M. Reincke ◽  
E. Moser ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Neuroendocrine Tumours ◽  
Surgical Techniques ◽  
Histological Finding ◽  
Operation Time ◽  
Emission Tomography ◽  
Minimally Invasive Surgical ◽  
Positron Emission ◽  
Parathyroid Adenomas ◽  
99Mtc Mibi

Summary:Preoperative localization of parathyroid adenomas (PA) can shorten operation time and improve curative rate; it becomes especially important in minimally invasive surgical techniques. Aim of this study was to investigate whether positron emission tomography (PET) with 3-,4-dihydroxy- 6-18F-fluorophenylalanine (18F-DOPA), which showed very promising results in other neuroendocrine tumours, also helps to localize PA. Patients, methods: Eight patients with proven primary hyperparathyroidism were studied preoperatively with PET. Seven also underwent scintigraphy with 99mTc-MIBI and ultrasonography of the neck. All patients were operated and the histological finding was used as a gold standard. Results: All eight patients had a histologically proven PA. None of the PA showed any detectable uptake of 18F-DOPA. However, ultrasonography detected 5/7 PA, scintigraphy detected 3/7 PA. Conclusion: These results suggest that PET with 18F-DOPA is not useful in the detection of PA in patients with primary hyperparathyroidism.

scholarly journals Is 18F-Fluorocholine-Positron Emission Tomography/Computerized Tomography a New Imaging Tool for Detecting Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism?

2014 ◽  
Vol 99 (12) ◽  
pp. 4531-4536 ◽  
Author(s):  
Laure Michaud ◽  
Alice Burgess ◽  
Virginie Huchet ◽  
Marine Lefèvre ◽  
Marc Tassart ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Secondary Hyperparathyroidism ◽  
Functional Imaging ◽  
Imaging Modality ◽  
Parathyroid Glands ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Preoperative Ultrasonography ◽  
99Mtc Sestamibi

Context: Preoperative ultrasonography and scintigraphy using 99mTc-sestamibi are commonly used to localize abnormal parathyroid glands. In cases of discrepant results between scintigraphy and ultrasonography, it is important to rely on another diagnostic imaging modality. 18F-fluorodeoxyglucose (FDG) and 11C-methionine positron emission tomography (PET) have been studied, but are imperfect to detect abnormal parathyroid glands. Recently, first cases of abnormal parathyroid glands taking-up radiolabelled choline were discovered incidentally in men referred to 11C-choline or 18F-fluorocholine (FCH)-PET/CT for prostate cancer. We checked if FCH uptake was a general feature of adenomatous or hyperplastic parathyroid glands. Methods: FCH-PET/CT was performed in 12 patients with primary (n = 8) or secondary hyperparathyroidism (1 dialyzed, 3 grafted) and with discordant or equivocal results on preoperative ultrasonography (US) and/or 123I/99mTc-sestamibi dual-phase scintigraphy. The results of the FCH-PET/CT were evaluated, with surgical exploration and histopathologic examination as the standard of truth. Results: On a per-patient level, the detection rate of FCH-PET/CT (at least one FCH focus corresponding to an abnormal parathyroid gland in a given patient) was 11/12 = 92%. FCH-PET/CT detected 18 foci interpreted as parathyroid glands and correctly localized 17 abnormal parathyroid glands (7 adenomas and 10 hyperplasias). On a per-lesion level, FCH-PET/CT results were 17 TP, 2 false negative ie, a lesion-based sensitivity of 89%, and 1 false positive. Conclusion: As the main result of this pilot study, we show that in patients with hyperparathyroidism and with discordant or equivocal results on scintigraphy or on ultrasonography, adenomatous or hyperplastic parathyroid glands can be localized by FCH-PET/CT with good accuracy. Furthermore, FCH-PET/CT can solve discrepant results between preoperative ultrasonography and scintigraphy and has thus a potential as a functional imaging modality in the detection of abnormal parathyroid glands. Our preliminary results are encouraging and prompt us to further evaluate FCH-PET/CT as a functional imaging agent in patients with biochemical hyperparathyroidism.

Motion correction in PET/CT

2005 ◽  
Vol 44 (S 01) ◽  
pp. S46-S50 ◽  
Author(s):  
M. Dawood ◽  
N. Lang ◽  
F. Büther ◽  
M. Schäfers ◽  
O. Schober ◽  
...  
Keyword(s):  
Optical Flow ◽  
Motion Correction ◽  
Motion Vector ◽  
Emission Tomography ◽  
Cardiac Pet ◽  
Novel Approach ◽  
Positron Emission ◽  
Pet Ct ◽  
Flow Algorithm ◽  
Motion Vector Field

Summary:Motion in PET/CT leads to artifacts in the reconstructed PET images due to the different acquisition times of positron emission tomography and computed tomography. The effect of motion on cardiac PET/CT images is evaluated in this study and a novel approach for motion correction based on optical flow methods is outlined. The Lukas-Kanade optical flow algorithm is used to calculate the motion vector field on both simulated phantom data as well as measured human PET data. The motion of the myocardium is corrected by non-linear registration techniques and results are compared to uncorrected images.

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