Assessment and Comparison of <sup>18</sup>F-Fluorocholine PET and <sup>99m</sup>Tc-Sestamibi Scans in Identifying Parathyroid Adenomas: A Metaanalysis
Julia Whitman, Isabel Elaine Allen, Emily K. Bergsland, Insoo Suh, Thomas A. Hope
Abstract
Hyperparathyroidism is an endocrine disorder caused by one or more hyperfunctioning parathyroid glands. Current imaging consisting of ultrasound and 99m Tc-sestamibi is imprecise, making localization difficult. 18 F-fluorocholine ( 18 F-FCH) PET has recently shown promise in presurgical localization of parathyroid adenomas. The primary aim of this study was to summarize the sensitivities and specificities of studies using 18 F-FCH PET to localize hyperparathyroidism. A secondary aim was to summarize a subset of studies in which 99m Tc-sestamibi scans were also used and to compare the performance of the 2 modalities. Methods: We searched the MEDLINE and EMBASE databases following the PRISMA (Preferred Reporting Items for Systematic Review and Metaanalysis) statement. Quality was assessed using the QUADAS-2 tool (Quality Assessment of Diagnostic Accuracy Studies). Twenty studies were included for quantitative assessment in our metaanalysis. A random-effects model and a hierarchic summary receiver-operating-characteristic model was used to summarize the sensitivity of 18 F-FCH PET in detecting abnormal parathyroid adenomas. We used the same methodology to assess sensitivity of 99m Tc-sestamibi, as a comparison to 18 F-FCH PET. Results: 18 F-FCH PET had a high sensitivity, 0.97 (range, 0.96-0.98), for the detection of abnormal parathyroid adenomas. In the subpopulation for which both 18 F-FCH and 99m Tc-sestamibi were reported, 18 F-FCH also had a higher sensitivity, 0.96 (0.94-0.98), than the 0.54 (0.29-0.79) reported for 99m Tc-sestamibi (P , 0.001). Conclusion: 18 F-FCH PET demonstrates high localization accuracy in patients with hyperparathyroidism. This metaanalysis supports the use of 18 F-FCH over 99m Tc-sestamibi in patients with hyperparathyroidism.