Refining the role of presurgical PET/4D-CT in a large series of patients with primary hyperparathyroidism undergoing [¹⁸F]Fluorocholine PET/CT.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-10-12 DOI:10.1111/eci.14336

Ashjan Kaseb, Houda Benider, Giorgio Treglia, Caterina Cusumano, Darejan Bessac, Pierpaolo Trimboli, Michel Vix, Arnoldo Piccardo, Adrien Latgé, Alessio Imperiale

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引用次数: 0

Abstract

Background: 4D-CT has garnered attention as complementary imaging for patients with primary hyperparathyroidism (pHPT). Herein we evaluated a diagnostic strategy using [¹⁸F]Fluorocholine Positron Emission Tomography/Computed Tomography (PET/CT), followed by 4D-CT integrated into PET/4D-CT after negative/inconclusive PET/CT results in a single-center retrospective cohort of 166 pHPT patients who underwent parathyroidectomy after [¹⁸F]Fluorocholine PET/4D-CT.

Methods: PET/CT and 4D-CT images were interpreted by three nuclear medicine physicians and one expert radiologist. Pathological findings were documented, and concordance rates were assessed. PET/CT results were categorized as positive/negative, with positive cases rated on a 3-level certitude scale: low, moderate, high. Inconclusive cases included low/moderate positivity. The added value of PET/4D-CT was assessed for negative/inconclusive cases through joint reading.

Results: PET/CT lesion-based analysis showed almost perfect interobserver concordance (Cohen's kappa >.8). Across the cohort, PET/CT had a sensitivity of 83%, specificity of 97%, PPV of 90% and NPV of 94%. For 4D-CT, these values were sensitivity: 53%, specificity: 84%, PPV: 56% and NPV: 82%. PET/CT was significantly more accurate than 4D-CT. Among 44 patients with negative/inconclusive results, PET/CT had sensitivity: 60%, specificity: 91%, PPV: 71% and NPV: 86%. In the same patients, sensitivity and specificity of the sequential diagnostic algorithm increased to 80% and 97%, showing significantly better global accuracy (92% vs. 83%) than standard PET/CT.

Conclusions: We support a personalized imaging algorithm for pHPT, placing [¹⁸F]Fluorocholine PET/CT at the forefront, followed by 4D-CT integrated into PET/4D-CT in the same imaging session for negative/inconclusive results. When PET/CT results are clearly positive, the additional sensitivity benefit of 4D-CT is minimal.

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在接受[18F]氟胆碱PET/CT检查的大量原发性甲状旁腺功能亢进症患者中完善手术前PET/4D-CT的作用。

背景：4D-CT作为原发性甲状旁腺功能亢进症（pHPT）患者的辅助成像手段已引起人们的关注。在此，我们评估了一种使用[18F]氟胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）的诊断策略，在PET/CT结果为阴性/不确定后，将4D-CT整合到PET/4D-CT中，对166名在[18F]氟胆碱PET/4D-CT后接受甲状旁腺切除术的pHPT患者进行了单中心回顾性队列研究：PET/CT 和 4D-CT 图像由三名核医学医生和一名放射科专家解读。记录病理结果并评估吻合率。PET/CT 结果分为阳性/阴性，阳性病例按 3 级可信度评分：低、中、高。不确定病例包括低度/中度阳性。对于阴性/不确定病例，通过联合阅片评估 PET/4D-CT 的附加值：基于 PET/CT 病灶的分析显示观察者之间几乎完全一致（Cohen's kappa >.8）。在整个队列中，PET/CT 的敏感性为 83%，特异性为 97%，PPV 为 90%，NPV 为 94%。4D-CT 的灵敏度为 53%，特异性为 84%，PPV 为 56%，NPV 为 82%。PET/CT 的准确性明显高于 4D-CT 。在 44 名结果为阴性/不确定的患者中，PET/CT 的灵敏度为 60%，特异性为 91%，PPV 为 71%，NPV 为 86%。在同样的患者中，顺序诊断算法的敏感性和特异性分别提高到了80%和97%，显示出明显优于标准PET/CT的整体准确性（92%对83%）：我们支持 pHPT 的个性化成像算法，将[18F]氟胆碱 PET/CT 放在首位，其次是 4D-CT 集成 PET/4D-CT，对于阴性/不确定的结果，在同一成像会话中进行 PET/4D-CT。当 PET/CT 结果明确为阳性时，4D-CT 所带来的额外灵敏度益处微乎其微。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.