ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Thyroid Endocrinology
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1595461
This article is part of the Research TopicMusculoskeletal Disorders Related to DysparathyroidismView all 4 articles
Conventional Imaging Techniques Plus 18 F-Fluorocholine PET/CT: A Comparative Study of Diagnostic Accuracy in Localizing Parathyroid Adenomas in Primary Hyperparathyroidism
Provisionally accepted
Wei-Yih Chiu*
Kuen-Yuan Chen
Chia-Tung Shun
Ming-Hsun WuKeh-Sung Tsai
Ching-Hung Chiu
Wei-Shiung Yang
Ruoh-Fang Yen- National Taiwan University Hospital, Taipei, Taiwan
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Background: Currently 18 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. 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 5 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.
Keywords: 18 F-Fluorocholine PET/CT, Neck ultrasound, Technetium-99m sestamibi scintigraphy, primary hyperparathyroidism, Parathyroid Hormone
Received: 20 Mar 2025; Accepted: 24 Jun 2025.
Copyright: © 2025 Chiu, Chen, Shun, Wu, Tsai, Chiu, Yang and Yen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei-Yih Chiu, National Taiwan University Hospital, Taipei, Taiwan
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