UCSF

The purpose of this prospective study was to determine the correct localization rate (CLR) of ¹⁸F-fluorocholine PET for the detection of parathyroid adenomas in comparison to ^99mTc-sestamibi imaging. Methods: This was a single-arm prospective trial. Ninety-eight patients with biochemical evidence of primary hyperparathyroidism were imaged before parathyroidectomy using ¹⁸F-fluorocholine PET/MRI. ^99mTc-sestamibi imaging performed separately from the study was evaluated for comparison. The primary endpoint of the study was the CLR on a patient level. Each imaging study was interpreted by 3 masked readers on a per-region basis. Lesions were validated by histopathologic analysis of surgical specimens. Results: Of the 98 patients who underwent ¹⁸F-fluorocholine PET, 77 subsequently underwent parathyroidectomy and 60 of those had ^99mTc-sestamibi imaging. For ¹⁸F-fluorocholine PET in patients who underwent parathyroidectomy, the CLR based on the masked reader consensus was 75% (95% CI, 0.63-0.82). In patients who underwent surgery and had an available ^99mTc-sestamibi study, the CLR increased from 17% (95% CI, 0.10-0.27) for ^99mTc-sestamibi imaging to 70% (95% CI, 0.59-0.79) for ¹⁸F-fluorocholine PET. Conclusion: In this prospective study using masked readers, the CLR for ¹⁸F-fluorocholine PET was 75%. In patients with a paired ^99mTc-sestamibi study, the use of ¹⁸F-fluorocholine PET increased the CLR from 17% to 70%. ¹⁸F-fluorocholine PET is a superior imaging modality for the localization of parathyroid adenomas.