Abstract：
The contribution of [18F]F-fluorocholine (FCH)-positron emission tomography (PET)/computed tomography (CT) in normocalcemic primary hyperparathyroidism (nPHPT) remains unknown.
To evaluate the sensitivity and specificity of FCH-PET/CT in a cohort of osteoporotic patients with nPHPT and discordant or negative [99mTc]Tc-sestamibi scintigraphy and ultrasonography who all underwent parathyroidectomy (PTX).
Longitudinal retrospective cohort study in patients referred for osteoporosis with mild biological primary hyperparathyroidism.
Tertiary referral center with expertise in bone metabolism and surgical management of hyperparathyroidism.
Among 109 patients with PHPT analyzed, 3 groups were individualized according to total serum calcium (tCa) and ionized calcium (iCa): 32 patients with hypercalcemia (HtCa group), 39 patients with normal tCa and elevated iCa (NtCa group), and 38 patients with both normal tCa and iCa (NiCa). All patients had biochemical follow-up confirming or not the success of PTX.
To evaluate the performance of FCH-PET/CT in terms of sensitivity and specificity, and to compare with first-line imaging procedures in the setting of nPHPT.
The sensitivity of FCH-PET/CT was 67% in the hypercalcemic group, 48% in the NtCa group (P = .05 vs HtCa), and 33% in the NiCa group (P = .004 vs HtCa). Specificity ranged from 97% to 99%. FCH-PET/CT was positive in 64.3% of patients with negative conventional imaging, with biochemical resolution after PTX in 77.8% of patients. Triple negative imaging was observed in 20 patients, with PHPT resolution in 85% of these patients.
This study highlights the contribution of FCH-PET/CT in a well-phenotyped cohort of normocalcemic patients with discordant or negative findings in [99mTc]Tc-sestamibi scintigraphy and ultrasonography. However, negative imaging in nPHPT does not rule out the possibility of surgical cure by an experienced surgeon.
To evaluate the sensitivity and specificity of FCH-PET/CT in a cohort of osteoporotic patients with nPHPT and discordant or negative [99mTc]Tc-sestamibi scintigraphy and ultrasonography who all underwent parathyroidectomy (PTX).
Longitudinal retrospective cohort study in patients referred for osteoporosis with mild biological primary hyperparathyroidism.
Tertiary referral center with expertise in bone metabolism and surgical management of hyperparathyroidism.
Among 109 patients with PHPT analyzed, 3 groups were individualized according to total serum calcium (tCa) and ionized calcium (iCa): 32 patients with hypercalcemia (HtCa group), 39 patients with normal tCa and elevated iCa (NtCa group), and 38 patients with both normal tCa and iCa (NiCa). All patients had biochemical follow-up confirming or not the success of PTX.
To evaluate the performance of FCH-PET/CT in terms of sensitivity and specificity, and to compare with first-line imaging procedures in the setting of nPHPT.
The sensitivity of FCH-PET/CT was 67% in the hypercalcemic group, 48% in the NtCa group (P = .05 vs HtCa), and 33% in the NiCa group (P = .004 vs HtCa). Specificity ranged from 97% to 99%. FCH-PET/CT was positive in 64.3% of patients with negative conventional imaging, with biochemical resolution after PTX in 77.8% of patients. Triple negative imaging was observed in 20 patients, with PHPT resolution in 85% of these patients.
This study highlights the contribution of FCH-PET/CT in a well-phenotyped cohort of normocalcemic patients with discordant or negative findings in [99mTc]Tc-sestamibi scintigraphy and ultrasonography. However, negative imaging in nPHPT does not rule out the possibility of surgical cure by an experienced surgeon.
摘要：
背景：[18F]氟胆碱（FCH）PET/CT在正常血钙原发性甲状旁腺功能亢进（nPHPT）中的作用尚不清楚。
目的：评估FCH-PET/CT在MIBI显像和超声检查不一致或阴性的骨质疏松性nPHPT患者队列中的敏感性和特异性，这些患者均接受了甲状旁腺切除术（PTX）。
方法：对患有轻度原发性甲状旁腺功能亢进的骨质疏松症患者进行纵向回顾性队列研究。
方法：拥有骨代谢和甲状旁腺功能亢进外科治疗专业知识的三级转诊中心。
方法：在109例PHPT患者中，三组根据血清总钙（tCa）和离子钙（iCa）进行个体化：32例高钙血症患者（HtCa组），39例tCa正常和iCa升高的患者（NtCa组），38例tCa和iCa（NiCa）均正常的患者。所有患者均进行了生化随访，证实了PTX是否成功。
方法：为了评估FCH-PET/CT在敏感性和特异性方面的性能，并与nPHPT设置中的一线成像程序进行比较。
结果：FCH-PET/CT在高钙血症中的敏感性为67％，NtCa组48%(p=0.05vsHtCa)，NiCa组为33%(p=0.004vsHtCa)。特异性范围从97%到99%。常规显像阴性的患者FCH-PET/CT阳性占64.3%,77.8%的患者在PTX后有生化分辨率。在20例患者中观察到三阴性影像学，这些患者的PHPT分辨率为85％。
结论：本研究强调了[18F]氟胆碱PET/CT在MIBI闪烁显像和超声检查结果不一致或阴性的正常血钙患者的表型队列中的贡献。然而,nPHTP的阴性成像并不排除由经验丰富的外科医生进行手术治愈的可能性.
目的：评估FCH-PET/CT在MIBI显像和超声检查不一致或阴性的骨质疏松性nPHPT患者队列中的敏感性和特异性，这些患者均接受了甲状旁腺切除术（PTX）。
方法：对患有轻度原发性甲状旁腺功能亢进的骨质疏松症患者进行纵向回顾性队列研究。
方法：拥有骨代谢和甲状旁腺功能亢进外科治疗专业知识的三级转诊中心。
方法：在109例PHPT患者中，三组根据血清总钙（tCa）和离子钙（iCa）进行个体化：32例高钙血症患者（HtCa组），39例tCa正常和iCa升高的患者（NtCa组），38例tCa和iCa（NiCa）均正常的患者。所有患者均进行了生化随访，证实了PTX是否成功。
方法：为了评估FCH-PET/CT在敏感性和特异性方面的性能，并与nPHPT设置中的一线成像程序进行比较。
结果：FCH-PET/CT在高钙血症中的敏感性为67％，NtCa组48%(p=0.05vsHtCa)，NiCa组为33%(p=0.004vsHtCa)。特异性范围从97%到99%。常规显像阴性的患者FCH-PET/CT阳性占64.3%,77.8%的患者在PTX后有生化分辨率。在20例患者中观察到三阴性影像学，这些患者的PHPT分辨率为85％。
结论：本研究强调了[18F]氟胆碱PET/CT在MIBI闪烁显像和超声检查结果不一致或阴性的正常血钙患者的表型队列中的贡献。然而,nPHTP的阴性成像并不排除由经验丰富的外科医生进行手术治愈的可能性.
