<sup>18</sup>F‐fluorocholine PET/CT in MEN1 Patients with Primary Hyperparathyroidism
Mathieu Gauthé, Anne Dierick‐Gallet, Thierry Delbot, Léopoldine Bricaire, Jérôme Bertherat, M.O. North, Béatrix Cochand‐Priollet, Philippe Bouchard, Jean‐Noël Talbot, Lionel Groussin, Sébastien Gaujoux
Abstract
Abstract Background Primary hyperparathyroidism (HPT1) is the most frequent endocrinopathy in multiple endocrine neoplasia type 1 (MEN1). Its surgical management is challenging. We aimed to describe and compare the imaging findings of parathyroid ultrasound (US), sestaMIBI scintigraphy (sestaMIBI), and 18 F‐fluorocholine (FCH) PET/CT in a series of MEN1 patients with HPT1. Methods Retrospective analysis of a cohort of MEN1 patients with HPT1 assessed by parathyroid US, sestaMIBI scintigraphy and SPECT/CT, and FCH‐PET/CT for potential surgery between 2015 and 2019. Results Twenty‐two patients with a confirmed diagnosis of MEN1 who presented with HPT1 and were assessed by the 3 imaging modalities were included. After imaging workups, 11 patients were operated on for the first time, 4 underwent a redo surgery, and 7 did not undergo an operation. The overall patient‐based positivity rate of imaging was 91% (20 of 22) for parathyroid US and 96% (21 of 22) for both sestaMIBI and FCH‐PET/CT. The 3 imaging modalities demonstrated negative findings in 1/22 patient who did not undergo surgery. Overall, 3 pathologic glands were not detected by any imaging technique. SestaMIBI and FCH‐PET/CT both resulted in the same 3 false‐positive results in ectopic areas with a significant uptake on two thymic carcinoid tumors and one inflammatory lymph node. FCH‐PET/CT provided more surgically relevant data than sestaMIBI in 4/11 patients with initial surgery and in 1/4 patient who underwent redo surgery. Conclusions Compared to sestaMIBI scintigraphy, FCH‐PET/CT provides additional information regarding the number of pathologic parathyroid glands and their localization in MEN1 patients with HPT1.