PETC/CT with 18F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism

I Bossert, S Chytiris, M Hodolic, L Croce, L Mansi, L Chiovato, G Mariani, G Trifirò

Research output: Contribution to journalArticlepeer-review


PURPOSE: Identification of pathologic parathyroid glands in primary hyperparathyroidism, traditionally based on neck ultrasound (US) and/or 99mTc-Sestamibi scintigraphy, can be challenging. PET/CT with 18F-Fluorocholine (18F-FCH) might improve the detection of pathologic parathyroid glands. We aimed at comparing the diagnostic performance of 18F-FCH-PET/CT with that of dual-phase dual-isotope parathyroid scintigraphy and neck US.

METHODS: Thirty-four consecutive patients with primary hyperparathyroidism were prospectively enrolled, 7 had normocalcemic hyperparathyroidism, and 27 had classic hypercalcemic hyperparathyroidism. All patients underwent high-resolution neck US, dual-phase dual-isotope 99mTc-Pertechnetate/99mTc-Sestamibi scintigraphy, and 18F-FCH-PET/CT.

RESULTS: In the whole patients' group, the detection rates of the abnormal parathyroid gland were 68% for neck US, 71% for 18F-FCH-PET/CT, and only 15% for 99mTc-Sestamibi scintigraphy. The corresponding figures in normocalcemic and hypercalcemic hyperparathyroidism were 57 and 70% for neck US, 70 and 71% for 18F-FCH-PET/CT, and 0 and 18% for 99mTc-Sestamibi scintigraphy, respectively. In the 17 patients in whom the abnormal parathyroid gland was identified, either at surgery or at fine needle aspiration cytology/biochemistry, the correct detection rate was 82% for neck US, 89% for 18F-FCH-PET/CT, and only 17% for 99mTc-Sestamibi scintigraphy.

CONCLUSIONS: 18F-FCH-PET/CT can be considered a first-line imaging technique for the identification of pathologic parathyroid glands in patients with normocalcemic and hypercalcemic hyperparathyroidism, even when the parathyroid volume is small.

Original languageEnglish
Pages (from-to)419-426
Number of pages8
JournalJournal of Endocrinological Investigation
Issue number4
Publication statusPublished - Apr 2019


  • Adult
  • Aged
  • Aged, 80 and over
  • Choline/analogs & derivatives
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Humans
  • Hypercalcemia/diagnostic imaging
  • Hyperparathyroidism/diagnostic imaging
  • Male
  • Middle Aged
  • Parathyroid Neoplasms/diagnostic imaging
  • Positron Emission Tomography Computed Tomography/methods
  • Prognosis
  • Radionuclide Imaging/methods
  • Radiopharmaceuticals
  • Ultrasonography/methods


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