Comparison of Neck Ultrasonography, Dual Phase (99m)Tc-Sestamibi with early SPECT-CT & (18)F-Fluorocholine PET-CT as First Line Imaging in Patients with Primary Hyperparathyroidism

INTRODUCTION: Successful surgical treatment for primary hyperparathyroidism requires accurate localization of abnormal parathyroid tissue in terms of location and number. Imaging is important for localizing the parathyroid adenoma, and there has been significant interest in (18)F-fluorocholine (FCH) positron emission tomography/computed tomography (PET/CT) for this purpose. AIM: This study attempted to ascertain the utility of (18)F-FCH PET/CT as a first-line investigation in preoperative localization of abnormal parathyroid tissue in primary hyperparathyroidism, in comparison with (99m)Tc-sestamibi dual-phase scintigraphy with early single-photon emission computed tomography (SPECT)/CT and neck ultrasonography. MATERIALS AND METHODS: Fifty-five patients with biochemical features of primary hyperparathyroidism were enrolled in this study. They underwent neck ultrasonography, (99m)Tc-sestamibi dual-phase scintigraphy with early SPECT/CT, and (18)F-FCH PET/CT for localization of parathyroid lesions. Thirty-three patients underwent surgical resection of the detected lesions. For two patients, clinical and biochemical follow-up was used as a gold standard. RESULTS: A total of 40 lesions were resected in the 33 patients who underwent surgery. A further two lesions were localized in two patients with clinical and biochemical follow-up as the gold standard. Of these 42 lesions, 41 were detected in preoperative imaging and 1 lesion was noted intraoperatively and resected. 41/42 lesions were detected by (18)F-FCH PET/CT (detection rate: 97.6%), 33/42 by (99m)Tc-sestamibi dual-phase scintigraphy with early SPECT/CT (detection rate: 78.5%), and 30/42 by neck ultrasonography (detection rate: 71.4%). CONCLUSION: Detection rates on (18)F-FCH PET/CT were superior to both (99m)Tc-sestamibi dual-phase scintigraphy with early SPECT/CT and neck ultrasonography in preoperative localization of parathyroid lesions in patients with primary hyperparathyroidism.