Clinical predictors of negative/equivocal SPECT imaging outcomes in primary hyperparathyroidism: Factors calling for 18 F-choline-PET.

Autor: Ferrari SB; Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland. Electronic address: ferrari.orl.usz@gmail.com., Morand GB; Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland; University of Zurich, Switzerland; Jewish General Hospital, McGill University, Montreal, QC, Canada., Rupp NJ; University of Zurich, Switzerland; Department of Pathology and Molecular Pathology, University Hospital Zurich, Switzerland., Krützfeldt J; Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Switzerland., Vetter D; Department of Visceral Surgery and Transplantation, University Hospital of Zurich, Switzerland., Hüllner MW; University of Zurich, Switzerland; Department of Nuclear Medicine, University Hospital Zurich, Switzerland., Broglie MA; Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Zurich, Switzerland.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2024 Jul-Aug; Vol. 45 (4), pp. 104315. Date of Electronic Publication: 2024 Apr 21.
DOI: 10.1016/j.amjoto.2024.104315
Abstrakt: Purpose: For minimally invasive surgery of parathyroid adenomas, exact localization diagnostics are essential. Main imaging modalities used for diagnostics are sonography, SPECT with/without CT (traditional imaging) and 18 F-choline-PET. The aim of our study was to identify predictors for inconclusive SPECT imaging and subsequently determine in which cases 18 F-choline-PET is needed.
Methods: Retrospective analysis of 138 patients with histologically confirmed primary hyperparathyroidism (pHPT). After sonography, patients underwent SPECT or SPECT/CT imaging, with subsequent 18 F-choline-PET in cases of disconcordant results. Logistic regression analysis was used to identify clinical and laboratory factors predictive for negative SPECT results.
Results: Sensitivity rates for sonography, SPECT, SPECT/CT, and choline-PET were 47 %, 49 %, 71.7 %, and 97 %, respectively. Logistic regression revealed lower PTH levels (p < 0.001), presence of structural thyroid disease (p = 0.018), and negative sonography (p < 0.001) as predictive of negative/equivocal SPECT outcome. An additional traditional imaging CT scan to a SPECT enhanced detection odds, as did greater adenoma weight. Urolithiasis, osteoporosis, and calcium values as measurement of activity and duration of disease showed no significant association with the detection rate. Furthermore, our study demonstrated that 18 F-choline-PET exhibited remarkable sensitivity in detecting adenomas among patients with negative/equivocal SPECT results.
Conclusion: Our study reveals potential predictive factors for a negative/equivocal SPECT outcome in pHPT. Identifying these factors might allow minimizing futile SPECT examinations and perhaps encourage timely utilization of 18 F-choline-PET imaging. Our study reinforces the clinical significance of 18 F-choline-PET, especially in complex cases with disconcordant results by conventional parathyroid imaging methods.
Competing Interests: Declaration of competing interest M.W.H. received grants and speaker honoraria from GE Healthcare, a fund by the Alfred and Annemarie von Sick legacy and a grant from the clinical research priority program (CRPP) Artificial Intelligence in Oncological Imaging Network of the University of Zurich. Otherwise this research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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