There are multiple imaging modalities in primary hyperparathyroidism. Ultrasound examination and subtraction scintigraphy are usually the first-line imaging techniques. When these results are negative or inconsistent, additional [11C]-methionine PET/CT (MET-PET/CT) or 4-dimensional computed tomography can be performed. ​This study aims to evaluate MET-PET/CT in comparison with other imaging techniques in primary hyperparathyroidism. This is a retrospective cohort study. Eighty-four patients with primary hyperparathyroidism, who underwent parathyroid surgery, were included. ​Imaging results have been correlated to the perioperative drop in parathyroid hormone level and to the pathological analysis. ​Descriptive statistics are used, supplemented with 95% Clopper–Pearson confidence intervals for sensitivity and specificity and a sub-analysis with the McNemar test on paired data only. The per-lesion sensitivity of MET-PET/CT seems higher than that of [99mTc]-sestamibi or [99mTc]-tetrofosmin and [99mTc]-pertechnetate subtraction scintigraphy. The McNemar test, on paired data only, shows significantly higher sensitivity of MET-PET/CT compared to ultrasound (p=0.039) and significantly higher specificity of ultrasound compared to subtraction scintigraphy (p=0.035).​ MET-PET/CT after inconclusive or negative ultrasound and/or subtraction scintigraphy has an additional value in 70% of the cases.​ Preoperative parathyroid hormone levels were higher in patients in whom MET-PET/CT correctly predicted the pathological parathyroid glands, compared to those where MET-PET/CT missed at least one adenoma. The same trend was seen for 4-dimensional computed tomography. In conclusion, MET-PET/CT seems a valuable imaging modality in primary hyperparathyroidism, at least as second line imaging approach, with a higher per-lesion sensitivity than ultrasound in such setting. Especially when ultrasound and/or subtraction scintigraphy are inconclusive or negative, MET-PET/CT directs the surgeon to the correct localization of the parathyroid adenoma.

中文翻译：

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[11C]-蛋氨酸PET/CT在甲状旁腺腺瘤术前定位中的价值

原发性甲状旁腺功能亢进症有多种影像学检查方式。超声检查和减影闪烁扫描通常是一线成像技术。当这些结果为阴性或不一致时，可以进行额外的 [11C]-蛋氨酸 PET/CT (MET-PET/CT) 或 4 维计算机断层扫描。本研究旨在与原发性甲状旁腺功能亢进症的其他成像技术相比，评估 MET-PET/CT。这是一项回顾性队列研究。84 名接受甲状旁腺手术的原发性甲状旁腺功能亢进患者被纳入研究。成像结果与围手术期甲状旁腺激素水平下降和病理分析相关。使用描述性统计，补充了 95% Clopper-Pearson 的敏感性和特异性置信区间，以及仅对配对数据进行 McNemar 检验的子分析。MET-PET/CT 的每个病灶敏感性似乎高于 [99mTc]-sestamibi 或 [99mTc]-tetrofosmin 和 [99mTc]-pertechnetate 减影闪烁扫描。McNemar 测试仅在配对数据上显示，与超声相比，MET-PET/CT 的灵敏度显着更高（p=0.039），并且与减影闪烁扫描（p=0.035）相比，超声的特异性显着更高（p=0.035）。在 70% 的病例中，不确定或阴性的超声和/或减影闪烁扫描具有附加价值。 MET-PET/CT 正确预测病理性甲状旁腺的患者术前甲状旁腺激素水平较高，与 MET-PET/CT 漏掉至少一个腺瘤的那些相比。4 维计算机断层扫描也看到了相同的趋势。总之，MET-PET/CT 似乎是原发性甲状旁腺功能亢进症的一种有价值的成像方式，至少作为二线成像方法，在这种情况下比超声具有更高的每病灶敏感性。尤其是当超声和/或减影闪烁扫描无定论或阴性时，MET-PET/CT 指导外科医生正确定位甲状旁腺腺瘤。