SPECIAL ARTICLE  NUCLEAR ENDOCRINOLOGY IN THE ERA OF PRECISION MEDICINE Free access

The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2022 June;66(2):130-40

DOI: 10.23736/S1824-4785.22.03440-9

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Multiple endocrine neoplasia type 1 or 4: detection of hyperfunctioning parathyroid glands with 18F-fluorocholine PET/CT. Illustrative cases and pitfalls

Jean-Noël TALBOT ¹, Jules ZHANG-YIN ¹, Khadoun KERROU ¹, Cyrielle AVELINE ¹, Benedicte VAGNE ¹, Ophélie BÉLISSANT ¹, Marc TASSART ², Sophie PÉRIÉ ³, Phillipe BOUCHARD ⁴, Sophie CHRISTIN-MAITRE ⁴, Fabrice MÉNÉGAUX ⁵, Lionel GROUSSIN ⁶, Sébastien GAUJOUX ⁷, Soňa BALOGOVÁ ^{1, 8} ✉, Françoise MONTRAVERS ¹

¹ Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France; ² Department of Radiology, Hôpital Tenon AP-HP, Sorbonne University, Paris, France; ³ Department of Head and Neck Surgery, Hôpital Tenon AP-HP, Sorbonne University, Paris, France; ⁴ Department of Endocrinology, Hôpital Saint-Antoine AP-HP, Sorbonne University, Paris, France; ⁵ Department of Surgery, Pitié-Salpétrière University Hospital, Sorbonne University, Paris, France; ⁶ Department of Endocrinology, Hôpital Cochin AP-HP, University of Paris, Paris, France; ⁷ Department of Pancreatic and Endocrine Surgery, Hôpital Cochin AP-HP, University of Paris, Paris, France; ⁸ Department of Nuclear Medicine, St. Elisabeth Oncology Institute, Comenius University, Bratislava, Slovakia

¹⁸F-fluorocholine (FCH) PET/CT is now well established to detect the hyperfunctioning parathyroid glands (HFPTG) in a case of sporadic primary hyperparathyroidism (pHPT), but only limited evidence is available about the utility of FCH PET/CT to detect the HFPTG in patients with multiple endocrine neoplasia (MEN) type 1 or 4. The pHPT in this context frequently consists in a multiglandular disease with small hyperplastic glands rather than adenomas, which is challenging for imaging modalities. The data of patients with MEN1 or MEN4 after parathyroidectomy referred to FCH PET/CT for presurgical localization of HFPTG were retrospectively reviewed, including follow-up after parathyroidectomy, in search for diagnostic performance and for potential pitfalls. In the present cohort, 16 patients referred to FCH PET/CT as part of their initial pHPT work-up were subsequently operated, 44 abnormal parathyroid glands (PT) were resected, of which 32 (73%) had been detected on FCH PET/CT and 2 considered as equivocal foci. Nine patients referred to FCH PET/CT for recurrent pHPT who were subsequently operated, 14 abnormal PT were resected, all had been detected on FCH PET/CT. FCH PET/CT permitted a unilateral approach for PTx in 4 of them. In one patient with MEN4 and pHPT, the HFPTG could not be visualized on FCH PET/CT but was localized by ultrasonography. Several causes of false positive or false negative results, incidental finding and pitfalls are listed and discussed. FCH PET/CT has a positive benefit/risk ratio in the detection of HFPTG in case of MEN1 (the data in MEN4 being currently very limited) with the most effective detection rate of current imaging modalities for HFPTG, few pitfalls, and an adequate impact on patient management compared to sesta MIBI SPECT and ultrasonography.

KEY WORDS: Fluorocholine; Multiple endocrine neoplasia; Hyperparathyroidism