Suzanne Garnier, Clémentine Mahéo, Gael Potard, Marie-Béatrice Cavarec, Nathalie Roudaut, Philippe Thuillier, Rémi Marianowski, Ronan Abgral, Jean-Christophe Leclere
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We conducted a retrospective, monocentric study, including 156 patients who underwent parathyroidectomy between 2017 and 2023. All patients underwent preoperative 18 F-fluorocholine PET-CT and had an indication for surgery due to primary hyperparathyroidism. A total of 156 patients were included in the study, the majority of whom were women (78%). Seven patients had multigland disease (4.49%). Sensitivity was 60.14% for cervical ultrasound, 46.21% for [99mTc]-MIBI scintigraphy, and 95.97% for 18 F-Fluorocholine PET-CT. 18 F-Fluorocholine PET-CT showed a higher sensitivity than cervical ultrasound and [99mTc]-MIBI scintigraphy, especially for multiple parathyroid adenomas (100, 57.14, and 42.86%, respectively). Univariate analysis showed better results for cervical ultrasound in men (p = 0.005). Larger adenomas showed better performance on [99mTc]-MIBI scintigraphy (p = 0.026), and elevated PTH levels were associated with significantly worse performance on 18 F-fluorocholine PET-CT (p = 0.023). Multivariate analysis showed that scintigraphy performance was worse in the presence of thyroid nodules (p = 0.049, RR = 2.046, 95% CI 1.005-4.166). 18 F-fluorocholine PET-CT is a valuable imaging modality for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism, with superior performance compared to conventional imaging modalities. 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引用次数: 0
摘要
18 f -氟胆碱PET-CT被认为是原发性甲状旁腺功能亢进患者甲状旁腺瘤术前定位的二线方法。目的是比较18f -氟胆碱PET-CT和标准成像方式在原发性甲状旁腺功能亢进患者甲状旁腺瘤术前定位中的诊断效果。主要目的是评估18f -氟胆碱PET-CT在阴性或标准成像不一致的情况下的表现。次要目的是评估18f -氟胆碱PET-CT和标准成像与患者特征的诊断性能。我们进行了一项回顾性、单中心研究，纳入了2017年至2023年间接受甲状旁腺切除术的156例患者。所有患者术前均行18f -氟胆碱PET-CT检查，并有原发性甲状旁腺功能亢进的手术指征。研究共纳入156例患者，其中大多数为女性（78%）。多腺体病变7例（4.49%）。宫颈超声灵敏度为60.14%，[99mTc]-MIBI显像灵敏度为46.21%，18 f -氟胆碱PET-CT灵敏度为95.97%。18 f -氟胆碱PET-CT的敏感性高于宫颈超声和[99mTc]-MIBI显像，尤其对多发甲状旁腺瘤的敏感性分别为100、57.14和42.86%。单因素分析显示，男性宫颈超声检查结果更好（p = 0.005）。较大的腺瘤在[99mTc]-MIBI显像上表现较好（p = 0.026）， PTH水平升高与18 f -氟胆碱PET-CT上表现明显较差相关（p = 0.023）。多因素分析显示，甲状腺结节存在时，闪烁成像表现较差（p = 0.049, RR = 2.046, 95% CI 1.005-4.166）。18 f -氟胆碱PET-CT是原发性甲状旁腺功能亢进症患者甲状旁腺瘤术前定位的一种有价值的成像方式，与传统成像方式相比具有优越的性能。[99mTc]-MIBI显像显示甲状腺结节存在时诊断效能降低。
Contribution of 18 F-fluorocholine PET-CT to the preoperative localisation of parathyroid adenoma for the treatment of primary hyperparathyroidism.
18 F-fluorocholine PET-CT is considered a second-line method for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism. The aim was to compare the diagnostic performance of 18 F-fluorocholine PET-CT and standard imaging modalities in the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism. The primary objective was to assess the performance of 18 F-fluorocholine PET-CT in cases of negative or discordant standard imaging. The secondary objective was to evaluate the diagnostic performance of both 18 F-fluorocholine PET-CT and standard imaging in relation to patient characteristics. We conducted a retrospective, monocentric study, including 156 patients who underwent parathyroidectomy between 2017 and 2023. All patients underwent preoperative 18 F-fluorocholine PET-CT and had an indication for surgery due to primary hyperparathyroidism. A total of 156 patients were included in the study, the majority of whom were women (78%). Seven patients had multigland disease (4.49%). Sensitivity was 60.14% for cervical ultrasound, 46.21% for [99mTc]-MIBI scintigraphy, and 95.97% for 18 F-Fluorocholine PET-CT. 18 F-Fluorocholine PET-CT showed a higher sensitivity than cervical ultrasound and [99mTc]-MIBI scintigraphy, especially for multiple parathyroid adenomas (100, 57.14, and 42.86%, respectively). Univariate analysis showed better results for cervical ultrasound in men (p = 0.005). Larger adenomas showed better performance on [99mTc]-MIBI scintigraphy (p = 0.026), and elevated PTH levels were associated with significantly worse performance on 18 F-fluorocholine PET-CT (p = 0.023). Multivariate analysis showed that scintigraphy performance was worse in the presence of thyroid nodules (p = 0.049, RR = 2.046, 95% CI 1.005-4.166). 18 F-fluorocholine PET-CT is a valuable imaging modality for the preoperative localisation of parathyroid adenomas in primary hyperparathyroidism, with superior performance compared to conventional imaging modalities. [99mTc]-MIBI scintigraphy showed reduced diagnostic performance in the presence of thyroid nodules.
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