{"title":"常规成像技术与18f -氟胆碱PET/CT：原发性甲状旁腺功能亢进诊断甲状旁腺瘤定位准确性的比较研究","authors":"Wei-Yih Chiu, Kuen-Yuan Chen, Chia-Tung Shun, Ming-Hsun Wu, Keh-Sung Tsai, Ching-Hung Chiu, Wei-Shiung Yang, Ruoh-Fang Yen","doi":"10.3389/fendo.2025.1595461","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Currently <sup>18</sup>F-Fluorocholine (FCH)-PET/CT is a choice beyond widely used techniques like ultrasound (US) and technetium-99m sestamibi (MIBI) for primary hyperparathyroidism (pHPT). It remains uncertain how FCH-PET/CT collaborates with those two traditional modalities. This study aims to prospectively evaluate the effectiveness of individual, complementary, and combined utilization of FCH-PET/CT for preoperative localization.</p><p><strong>Methods: </strong>All participants underwent US, MIBI, and FCH-PET/CT examinations, and eligible patients underwent parathyroid surgery based on surgical indications and patient preferences. McNemar's test compared diagnostic performance between imaging techniques and Spearman's rank correlation correlated FCH-PET/CT parameters with lesion volume, laboratory, and histological features.</p><p><strong>Results: </strong>63 out of 83 recruited patients underwent parathyroidectomy. Histologically confirmed parathyroid lesions were found in 69 glands among 63 patients. FCH-PET/CT exhibited higher sensitivity than US, MIBI, and US/MIBI combination (87.0% vs. 49.3%, <i>P <</i>0.001; vs. 49.3%, <i>P <</i>0.001; vs. 66.7%, <i>P</i>=0.006). As a second-line modality after US, MIBI, and US/MIBI combination, FCH-PET/CT achieved sensitivities of 88.6%, 77.1%, and 80.9% in detecting US-negative lesions, MIBI-negative lesions, and lesions with negative or conflicting US/MIBI results, respectively. Among various imaging combinations, the combined use of US and FCH-PET/CT showed significantly higher sensitivity than FCH-PET/CT alone (94.2% vs. 87.0%, <i>P</i>=0.025) and similar sensitivity with higher specificity than the combination of all three modalities (sensitivity: 94.2% vs. 95.7%, <i>P</i>=0.317; specificity: 98.9% vs. 95.1%, <i>P</i>=0.008).</p><p><strong>Conclusions: </strong>FCH-PET/CT is effective as a first-line or complementary technique, irrespective of prior US, MIBI or US/MIBI combination. US combined with FCH-PET/CT appears to be the most effective localization strategy among the modalities evaluated in this study. Our findings support an ultrasound-first approach for localizing primary hyperparathyroidism, with FCH-PET/CT referral in uncertain cases to enhance success rates.</p>","PeriodicalId":12447,"journal":{"name":"Frontiers in Endocrinology","volume":"16 ","pages":"1595461"},"PeriodicalIF":4.6000,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301907/pdf/","citationCount":"0","resultStr":"{\"title\":\"Conventional imaging techniques plus <sup>18</sup>F-Fluorocholine PET/CT: a comparative study of diagnostic accuracy in localizing parathyroid adenomas in primary hyperparathyroidism.\",\"authors\":\"Wei-Yih Chiu, Kuen-Yuan Chen, Chia-Tung Shun, Ming-Hsun Wu, Keh-Sung Tsai, Ching-Hung Chiu, Wei-Shiung Yang, Ruoh-Fang Yen\",\"doi\":\"10.3389/fendo.2025.1595461\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Currently <sup>18</sup>F-Fluorocholine (FCH)-PET/CT is a choice beyond widely used techniques like ultrasound (US) and technetium-99m sestamibi (MIBI) for primary hyperparathyroidism (pHPT). It remains uncertain how FCH-PET/CT collaborates with those two traditional modalities. This study aims to prospectively evaluate the effectiveness of individual, complementary, and combined utilization of FCH-PET/CT for preoperative localization.</p><p><strong>Methods: </strong>All participants underwent US, MIBI, and FCH-PET/CT examinations, and eligible patients underwent parathyroid surgery based on surgical indications and patient preferences. McNemar's test compared diagnostic performance between imaging techniques and Spearman's rank correlation correlated FCH-PET/CT parameters with lesion volume, laboratory, and histological features.</p><p><strong>Results: </strong>63 out of 83 recruited patients underwent parathyroidectomy. Histologically confirmed parathyroid lesions were found in 69 glands among 63 patients. FCH-PET/CT exhibited higher sensitivity than US, MIBI, and US/MIBI combination (87.0% vs. 49.3%, <i>P <</i>0.001; vs. 49.3%, <i>P <</i>0.001; vs. 66.7%, <i>P</i>=0.006). As a second-line modality after US, MIBI, and US/MIBI combination, FCH-PET/CT achieved sensitivities of 88.6%, 77.1%, and 80.9% in detecting US-negative lesions, MIBI-negative lesions, and lesions with negative or conflicting US/MIBI results, respectively. Among various imaging combinations, the combined use of US and FCH-PET/CT showed significantly higher sensitivity than FCH-PET/CT alone (94.2% vs. 87.0%, <i>P</i>=0.025) and similar sensitivity with higher specificity than the combination of all three modalities (sensitivity: 94.2% vs. 95.7%, <i>P</i>=0.317; specificity: 98.9% vs. 95.1%, <i>P</i>=0.008).</p><p><strong>Conclusions: </strong>FCH-PET/CT is effective as a first-line or complementary technique, irrespective of prior US, MIBI or US/MIBI combination. US combined with FCH-PET/CT appears to be the most effective localization strategy among the modalities evaluated in this study. Our findings support an ultrasound-first approach for localizing primary hyperparathyroidism, with FCH-PET/CT referral in uncertain cases to enhance success rates.</p>\",\"PeriodicalId\":12447,\"journal\":{\"name\":\"Frontiers in Endocrinology\",\"volume\":\"16 \",\"pages\":\"1595461\"},\"PeriodicalIF\":4.6000,\"publicationDate\":\"2025-07-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12301907/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Frontiers in Endocrinology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3389/fendo.2025.1595461\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Frontiers in Endocrinology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3389/fendo.2025.1595461","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
背景：目前，18f -氟胆碱(FCH)-PET/CT是除超声（US）和tech -99m sestamibi （MIBI）等广泛使用的技术外治疗原发性甲状旁腺功能亢进（pHPT）的一种选择。目前仍不确定FCH-PET/CT如何与这两种传统模式合作。本研究旨在前瞻性评估FCH-PET/CT在术前定位中的单独、补充和联合应用的有效性。方法：所有参与者均接受US、MIBI和FCH-PET/CT检查，符合条件的患者根据手术指征和患者偏好接受甲状旁腺手术。McNemar的测试比较了成像技术和Spearman等级相关性（FCH-PET/CT参数与病变体积、实验室和组织学特征相关）之间的诊断性能。结果：83例患者中有63例接受了甲状旁腺切除术。组织学证实63例患者中有69个腺体有甲状旁腺病变。FCH-PET/CT的敏感性高于US、MIBI和US/MIBI联合(87.0% vs 49.3%, P 0.001；对比49.3%,P 0.001；vs. 66.7%， P=0.006)。FCH-PET/CT作为继US、MIBI、US/MIBI联合检查之后的二线检查方式，在US阴性病灶、MIBI阴性病灶、US/MIBI阴性或相互冲突的病灶检测上的灵敏度分别为88.6%、77.1%和80.9%。在各种影像组合中，US与FCH-PET/CT联合使用的灵敏度明显高于单独使用FCH-PET/CT (94.2% vs. 87.0%， P=0.025)，灵敏度相似且特异性更高(灵敏度：94.2% vs. 95.7%， P=0.317；特异性：98.9%对95.1%，P=0.008)。结论：FCH-PET/CT作为一线或辅助技术是有效的，与先前的US、MIBI或US/MIBI联合无关。US联合FCH-PET/CT似乎是本研究中评估的模式中最有效的定位策略。我们的研究结果支持超声优先定位原发性甲状旁腺功能亢进的方法，在不确定的病例中使用FCH-PET/CT转诊以提高成功率。
Conventional imaging techniques plus 18F-Fluorocholine PET/CT: a comparative study of diagnostic accuracy in localizing parathyroid adenomas in primary hyperparathyroidism.
Background: Currently 18F-Fluorocholine (FCH)-PET/CT is a choice beyond widely used techniques like ultrasound (US) and technetium-99m sestamibi (MIBI) for primary hyperparathyroidism (pHPT). It remains uncertain how FCH-PET/CT collaborates with those two traditional modalities. This study aims to prospectively evaluate the effectiveness of individual, complementary, and combined utilization of FCH-PET/CT for preoperative localization.
Methods: All participants underwent US, MIBI, and FCH-PET/CT examinations, and eligible patients underwent parathyroid surgery based on surgical indications and patient preferences. McNemar's test compared diagnostic performance between imaging techniques and Spearman's rank correlation correlated FCH-PET/CT parameters with lesion volume, laboratory, and histological features.
Results: 63 out of 83 recruited patients underwent parathyroidectomy. Histologically confirmed parathyroid lesions were found in 69 glands among 63 patients. FCH-PET/CT exhibited higher sensitivity than US, MIBI, and US/MIBI combination (87.0% vs. 49.3%, P <0.001; vs. 49.3%, P <0.001; vs. 66.7%, P=0.006). As a second-line modality after US, MIBI, and US/MIBI combination, FCH-PET/CT achieved sensitivities of 88.6%, 77.1%, and 80.9% in detecting US-negative lesions, MIBI-negative lesions, and lesions with negative or conflicting US/MIBI results, respectively. Among various imaging combinations, the combined use of US and FCH-PET/CT showed significantly higher sensitivity than FCH-PET/CT alone (94.2% vs. 87.0%, P=0.025) and similar sensitivity with higher specificity than the combination of all three modalities (sensitivity: 94.2% vs. 95.7%, P=0.317; specificity: 98.9% vs. 95.1%, P=0.008).
Conclusions: FCH-PET/CT is effective as a first-line or complementary technique, irrespective of prior US, MIBI or US/MIBI combination. US combined with FCH-PET/CT appears to be the most effective localization strategy among the modalities evaluated in this study. Our findings support an ultrasound-first approach for localizing primary hyperparathyroidism, with FCH-PET/CT referral in uncertain cases to enhance success rates.
期刊介绍：
Frontiers in Endocrinology is a field journal of the "Frontiers in" journal series.
In today’s world, endocrinology is becoming increasingly important as it underlies many of the challenges societies face - from obesity and diabetes to reproduction, population control and aging. Endocrinology covers a broad field from basic molecular and cellular communication through to clinical care and some of the most crucial public health issues. The journal, thus, welcomes outstanding contributions in any domain of endocrinology.
Frontiers in Endocrinology publishes articles on the most outstanding discoveries across a wide research spectrum of Endocrinology. The mission of Frontiers in Endocrinology is to bring all relevant Endocrinology areas together on a single platform.
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