Head-to-head comparison of [11C]methionine PET, [11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism,European Journal of Nuclear Medicine and Molecular Imaging

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Head-to-head comparison of [11C]methionine PET, [11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism
European Journal of Nuclear Medicine and Molecular Imaging ( IF 8.6 ) Pub Date : 2023-11-17 , DOI: 10.1007/s00259-023-06488-7
Milou E Noltes _{1,

2,

3} , Schelto Kruijff _{1,

2,

4} , Auke P A Appelman ₅ , Liesbeth Jansen ₂ , Wouter T Zandee ₆ , Thera P Links ₆ , Bettien M van Hemel ₇ , Hugo M Schouw _{1,

2} , Rudi A J O Dierckx _{1,

3} , Anne Brecht Francken ₈ , Wendy Kelder ₃ , Anouk van der Hoorn ₅ , Adrienne H Brouwers ₁

Affiliation

Purpose

Accurate preoperative localization is imperative to guide surgery in primary hyperparathyroidism (pHPT). It remains unclear which second-line imaging technique is most effective after negative first-line imaging. In this study, we compare the diagnostic effectiveness of [¹¹C]methionine PET/CT, [¹¹C]choline PET/CT, and four dimensional (4D)-CT head-to-head in patients with pHPT, to explore which of these imaging techniques to use as a second-line scan.

Methods

We conducted a powered, prospective, blinded cohort study in patients with biochemically proven pHPT and prior negative or discordant first-line imaging consisting of ultrasonography and ^99mTc-sestamibi. All patients underwent [¹¹C]methionine PET/CT, [¹¹C]choline PET/CT, and 4D-CT. At first, all scans were interpreted by a nuclear medicine physician, and a radiologist who were blinded from patient data and all imaging results. Next, a non-blinded scan reading was performed. The scan results were correlated with surgical and histopathological findings. Serum calcium values at least 6 months after surgery were used as gold standard for curation of HPT.

Results

A total of 32 patients were included in the study. With blinded evaluation, [¹¹C]choline PET/CT was positive in 28 patients (88%), [¹¹C]methionine PET/CT in 23 (72%), and 4D-CT in 15 patients (47%), respectively. In total, 30 patients have undergone surgery and 32 parathyroid lesions were histologically confirmed as parathyroid adenomas. Based on the blinded evaluation, lesion-based sensitivity of [¹¹C]choline PET/CT, [¹¹C]methionine PET/CT, and 4D-CT was respectively 85%, 67%, and 39%. The sensitivity of [¹¹C]choline PET/CT differed significantly from that of [¹¹C]methionine PET/CT and 4D-CT (p = 0.031 and p < 0.0005, respectively).

Conclusion

In the setting of pHPT with negative first-line imaging, [¹¹C]choline PET/CT is superior to [¹¹C]methionine PET/CT and 4D-CT in localizing parathyroid adenomas, allowing correct localization in 85% of adenomas. Further studies are needed to determine cost–benefit and efficacy of these scans, including the timing of these scans as first- or second-line imaging techniques.

中文翻译：

[11C]蛋氨酸 PET、[11C]胆碱 PET 和 4 维 CT 作为二线扫描检测原发性甲状旁腺功能亢进症甲状旁腺腺瘤的头对头比较

目的

准确的术前定位对于指导原发性甲状旁腺功能亢进症（pHPT）的手术至关重要。目前尚不清楚哪种二线成像技术在一线成像阴性后最有效。在本研究中，我们比较了 [ ¹¹ C]蛋氨酸 PET/CT、[ ¹¹ C]胆碱 PET/CT 和四维 (4D)-CT 对 pHPT 患者的诊断效果，以探讨这些成像技术用作二线扫描。

方法

我们对经生化证实的 pHPT 且先前一线影像（包括超声检查和^99m Tc-sestamibi）呈阴性或不一致的患者进行了一项有力的、前瞻性的、盲法队列研究。所有患者均接受[ ¹¹ C]蛋氨酸PET/CT、[ ¹¹ C]胆碱PET/CT和4D-CT。起初，所有扫描结果均由核医学医师和放射科医生解读，他们对患者数据和所有成像结果不知情。接下来，进行非盲扫描读取。扫描结果与手术和组织病理学结果相关。术后至少 6 个月的血清钙值被用作治疗 HPT 的金标准。

结果

该研究共有 32 名患者。通过盲法评估，分别有 28 名患者 (88%) 的 [ ¹¹ C]胆碱 PET/CT 呈阳性，23 名患者 (72%) 的 [ ¹¹ C]蛋氨酸 PET/CT 呈阳性，15 名患者 (47%) 的 4D-CT 呈阳性。。共有30名患者接受了手术，32个甲状旁腺病灶经组织学证实为甲状旁腺腺瘤。基于盲法评估，[ ¹¹ C]胆碱PET/CT、[ ¹¹ C]蛋氨酸PET/CT和4D-CT基于病变的敏感性分别为85%、67%和39%。 [ ¹¹ C]胆碱PET/CT的敏感性与[ ¹¹ C]蛋氨酸PET/CT和4D-CT的敏感性显着不同（分别为p = 0.031和p < 0.0005）。