Superior sensitivity of 18 F-fluorocholine: PET localization in primary hyperparathyroidism.

Background: Preoperative parathyroid imaging guides surgeons during parathyroidectomy. This study evaluates the clinical impact of ¹⁸ F-fluorocholine positron emission tomography for preoperative parathyroid localization on patients with primary hyperparathyroidism.
Methods: Patients with primary hyperparathyroidism and indications for parathyroidectomy had simultaneous ¹⁸ F-fluorocholine positron emission tomography imaging/magnetic resonance imaging. In patients who underwent subsequent parathyroidectomy, cure was based on lab values at least 6 months after surgery. Location-based sensitivity and specificity of ¹⁸ F-fluorocholine positron emission tomography imaging was assessed using 3 anatomic locations (left neck, right neck, and mediastinum), with surgery as the gold standard.
Results: In 101 patients, ¹⁸ F-fluorocholine positron emission tomography localized at least 1 candidate lesion in 93% of patients overall and in 91% of patients with previously negative imaging, leading to a change in preoperative strategy in 60% of patients. Of 76 patients who underwent parathyroidectomy, 58 (77%) had laboratory data at least 6 months postoperatively, with 55/58 patients (95%) demonstrating cure. ¹⁸ F-fluorocholine positron emission tomography successfully guided curative surgery in 48/58 (83%) patients, compared with 20/57 (35%) based on ultrasound and 13/55 (24%) based on sestamibi. In a location-based analysis, sensitivity of ¹⁸ F-fluorocholine positron emission tomography (88.9%) outperformed both ultrasound (37.1%) and sestamibi (27.5%), as well as ultrasound and sestamibi combined (47.8%).
Conclusion: Long-term results in the first cohort in the United States to use ¹⁸ F-fluorocholine positron emission tomography for parathyroid localization confirm its utility in a challenging cohort, with better sensitivity than ultrasound or sestamibi.
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