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We aimed to assess the value of 11 C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99m Tc-sestamibi imaging and neck ultrasound. Methods: Eighty-seven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUV max and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11 C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had false-positive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUV max was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11 C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99m Tc-sestamibi imaging yield negative or discordant results.

the journal of nuclear medicine

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of <sup>11</sup>C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and <sup>99m</sup>Tc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99mTc-Sestamibi SPECT/CT

Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of ¹¹C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and ^99mTc-Sestamibi SPECT/CT