Will 18 F-fluorocholine PET/CT replace other methods of preoperative parathyroid imaging?
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REVIEW
Will 18F-fluorocholine PET/CT replace other methods of preoperative parathyroid imaging? Luca Giovanella
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Lorenzo Bacigalupo3 Giorgio Treglia1,4,5 Arnoldo Piccardo3 ●
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Received: 15 June 2020 / Accepted: 28 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Introduction Primary hyperparathyroidism (PHPT) is a common endocrine disorder usually due to hyperfunctioning parathyroid glands (HPs). Surgical removal of the HPs is the main treatment for PHPT, making the correct detection and localization of HPs crucial to guiding targeted and minimally invasive surgical treatment in patients with PHPT. To date, different imaging methods have been used to detect and localize HPs, including radiology, nuclear medicine, and hybrid techniques. Methods The present work discusses the role and value of different imaging methods in PHPT and, particularly, evaluates the potential role of 18F-fluorcholine PET/CT as a “one-stop-shop” method for preoperative parathyroid localization in patients with PHPT. Discussion Cervical ultrasound (US) and parathyroid scintigraphy using 99mTc-MIBI are the most commonly employed methods in clinical practice. More recently, four-dimensional computed tomography (4D CT) and positron emission tomography (PET) with radiolabeled choline have emerged as useful alternatives in cases of negative or discordant findings from first-line imaging methods. Conclusions Due to the excellent diagnostic performance of radiolabeled choline PET/CT and the low radiation burden, this technique seems to be an ideal candidate to substitute current imaging procedures including US, MIBI scintigraphy, 4D CT and MRI and perform a fast and reliable “one-stop-shop” preoperative localization of HP in patients with PHPT, including challenging cases of postoperative persistent/recurrent disease. Keywords Primary hyperparathyroidism Ultrasound scintigraphy Positron emission tomography ●
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Introduction Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02487-y) contains supplementary material, which is available to authorized users. * Luca Giovanella [email protected] 1
Clinic for Nuclear Medicine and Molecular Imaging, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
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Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
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Department of Diagnostic Imaging, Radiology and Nuclear Medicine, Ente Ospedaliero Galliera, Genova, Italy
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Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Research and Innovation Service, Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
Primary hyperparathyroidism (PHPT), the third most common endocrine disease, is caused by one or more overactive parathyroid glands and affects women two to three times more often than men. The diagnosis may be
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