OBJECTIVE To compare detectability of hyperfunctioning parathyroid tissue (HPT) by digital and analog 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT. MATERIALS AND METHODS Thirty-three patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT were prospectively included. All patients accepted to be scanned by digital and analog PET/CT in the same imaging session after a single injection of 18F-fluorocholine. Three nuclear medicine physicians evaluated the digital and analog PET/CT datasets to assess the detection rate of HPT. Maximum standard uptake values (SUVmax) of HPT and locoregional lymph nodes were measured in both systems. RESULTS HPT was detected in 30/33 patients by the digital system, whereas it was detected in 22/33 patients by the analog system (p < 0.01). Moreover, in 21 of these 33 patients, both systems detected one focal 18F-fluorocholine uptake, and in one patient the digital system detected two foci. Histopathology demonstrated HPT in 32 patients and it was inconclusive in one patient. The digital PET/CT detected HPT in 29 of the 32 patients, and the analog system in 22 of the 32 (p < 0.01). All HPT suspected lesions resected and detected only by the digital system (n = 8) were < 10 mm (7.5 ± 1.3 mm), while those detected by both systems (n = 22) were > 10 mm (13 ± 3.8 mm). SUVmax of HPT lesions was significantly higher than SUVmax of locoregional lymph node independently of the PET/CT system used (4.5 ± 1.9 vs. 2.9 ± 1.3, p < 0.0001). CONCLUSIONS Digital PET/CT offers superior performance over analog system in patients with suspected HPT and previous negative/inconclusive imaging examinations, particularly in sub-centimeter lesions. SUVmax can help in the differentiation between HTP and locoregional lymph nodes.

中文翻译：

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18F-氟胆碱数字PET / CT在检测甲状旁腺腺瘤中的卓越性能。

目的比较数字和模拟18F-氟胆碱PET / CT对原发性甲状旁腺功能亢进和99mTc-MIBI闪烁显像-SPECT / CT患者的甲状旁腺功能亢进组织（HPT）的可检测性。材料与方法前瞻性纳入了33例原发性甲状旁腺功能亢进和99mTc-MIBI闪烁显像-SPECT / CT阴性/不确定的患者。在单次注射18F-氟胆碱后，所有患者均接受在同一次成像过程中通过数字和模拟PET / CT进行扫描。三名核医学医师评估了数字和模拟PET / CT数据集，以评估HPT的检出率。在两个系统中均测量了HPT和局部淋巴结的最大标准摄入值（SUVmax）。结果通过数字系统在30/33位患者中检测到HPT，而通过模拟系统在22/33例患者中检测到了这一现象（p <0.01）。此外，在这33位患者中的21位中，两个系统都检测到一个局灶性18F-氟胆碱摄取，而在一位患者中，数字系统检测到两个病灶。组织病理学证实32例HPT，其中1例尚无定论。数字PET / CT在32例患者中有29例检测到HPT，在32例中22例中检测到模拟系统（p <0.01）。仅通过数字系统（n = 8）切除和检测到的所有HPT可疑病变均小于10毫米（7.5±1.3毫米），而通过两个系统（n = 22）检测出的那些均大于10毫米（13±3.8毫米）。独立于所使用的PET / CT系统，HPT病变的SUVmax显着高于局部淋巴结的SUVmax（4.5±1.9对2.9±1.3，p <0.0001）。结论在怀疑有HPT和既往阴性/不确定影像学检查的患者中，尤其是在亚厘米级病变中，数字PET / CT可提供优于模拟系统的性能。SUVmax可以帮助区分HTP和局部淋巴结。