How nuclear imaging changed parathyroid surgical strategies through time

Le résumé fourni par la source

In 1986, John Doppman made the statement that “the only localization study indicated in a patient with untreated hyperparathyroidism (HPT) is the localization of an experienced parathyroid surgeon” [ 1 ]. Nowadays, preoperative localization with several available imaging techniques aids the surgeon in identifying an adenoma preoperatively. Recently, to identify the best second-line imaging, Noltes et al. published the first prospective study in which [ 11 C]-methionine PET/CT, [ 11 C]-choline PET/CT, and 4D-CT were compared in the same patient with primary hyperparathyroidism (pHPT) [ 2 ]. This study showed that [ 11 C]-choline PET/CT had a sensitivity of 85% for localizing parathyroid adenomas as second-line imaging technique. Considering that in this study only patients with upfront negative or discordant first-line imaging were included, the diagnostic performance of [ 11 C]-choline PET/CT is impressive. A growing number of endocrine departments are now implementing choline PET imaging in their clinic in a first-line fashion [ 3 , 4 ].

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