PURPOSE Hyperparathyroidism (HPT) is a common disorder. A cure can only be achieved by removing all diseased glands. It is critical to localize the hyperfunctioning glands exactly to prevent extensive surgical exploration. The number of false negative/inconclusive results in standard imaging techniques is high. We aimed to evaluate the diagnostic accuracy of 18F-Fluorocholine-PET in combination with contrast-enhanced CT (FCH-PET/CT) and its sensitivity in patients with primary, secondary/tertiary, and familial HPT with negative and/or discordant findings in ultrasound and/or 99mTc-sestamibi scintigraphy/SPECT/CT. METHODS A total of 96 patients with HPT and negative/equivocal conventional imaging were referred for FCH-PET/CT. In this retrospective, single institution study, 69 patients, who have undergone surgery and histopathologic workup, were analyzed. Of the 69 patients included, 60 patients suffered from primary HPT, four from secondary or tertiary HPT, and five from familial HPT. Sensitivities, positive predictive values, and accuracies were calculated. RESULTS Sensitivity/positive predictive value (PPV) per lesion was 87.5/98.3% for primary HPT, 75/100% for secondary/tertiary HPT and 25/66.7% for familial HPT. Sensitivity/PPV per patient was 91.5/98.2% for primary HPT, 100/100% for secondary/tertiary HPT and 50/100% for familial HPT. All patients showed normalized serum calcium levels in the postoperative period. The follow-up rate was 97%. Of the patients included in the study, 58 of 60 patients with primary HPT, and four of four patients with secondary/tertiary HPT showed normal calcium and parathyroid hormone (PTH) levels after six months and were cured. Of the patients with familial HPT, four of five patients were cured. CONCLUSION Diagnostic accuracy of 18F-Fluorocholine-PET/CT for patients with pHPT is excellent. 18F-Fluorocholine-PET/CT is a valuable tool for endocrine surgeons to optimize the surgical treatment of patients with hyperparathyroidism.

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18F-氟胆碱-PET联合增强CT对甲状旁腺功能亢进症患者的定位及优化手术治疗[J].

目的 甲状旁腺功能亢进症 (HPT) 是一种常见疾病。只有切除所有患病的腺体才能治愈。准确定位功能亢进的腺体以防止广泛的手术探查至关重要。标准成像技术中的假阴性/不确定结果的数量很高。我们旨在评估 18F-氟胆碱-PET 联合对比增强 CT (FCH-PET/CT) 的诊断准确性及其对原发性、继发性/三级和家族性 HPT 患者的诊断准确性，这些患者的结果为阴性和/或不一致。超声和/或 99mTc-sestamibi 闪烁显像/SPECT/CT。方法 共有 96 名 HPT 和常规影像阴性/模棱两可的患者被转诊进行 FCH-PET/CT。在这项回顾性、单一机构研究中，69 名接受过手术和组织病理学检查的患者，进行了分析。在纳入的 69 名患者中，60 名患者患有原发性 HPT，4 名患者患有继发性或三级 HPT，5 名患者患有家族性 HPT。计算灵敏度、阳性预测值和准确度。结果 每个病灶的敏感性/阳性预测值 (PPV) 分别为：原发性 HPT 为 87.5/98.3%，继发性/第三性 HPT 为 75/100%，家族性 HPT 为 25/66.7%。每名患者的敏感性/PPV 对于初级 HPT 为 91.5/98.2%，对于二级/三级 HPT 为 100/100%，对于家族性 HPT 为 50/100%。所有患者在术后期间均显示正常的血清钙水平。随访率为97%。在纳入研究的患者中，60 名原发性 HPT 患者中的 58 名和 4 名继发/三级 HPT 患者中的 4 名在六个月后显示正​​常的钙和甲状旁腺激素 (PTH) 水平并治愈。在患有家族性 HPT 的患者中，5 名患者中有 4 名治愈。结论 18F-氟胆碱-PET/CT 对pHPT 患者的诊断准确性极佳。18F-氟胆碱-PET/CT 是内分泌外科医生优化甲状旁腺功能亢进患者手术治疗的宝贵工具。