Diagnostic Performance of 99mTc-Sestamibi SPECT/CT and 18F-Choline PET/CT in Locating Hyperfunctioning Parathyroid Glands in Patients with Primary Hyperparathyroidism.

Objective: This study aimed to assess the diagnostic performance of ^99mTc-sestamibi SPECT/CT and ¹⁸F-choline PET/CT in detecting hyperfunctioning parathyroid glands in patients undergoing surgery for primary hyperparathyroidism (PHPT).

Methods: A retrospective analysis was conducted on patients who underwent PHPT-related surgery between April 2019 and May 2022. The study focused on patients undergoing either ^99mTc-sestamibi SPECT/CT (81 patients) or ¹⁸F-choline PET/CT (33 patients) scans before surgery to pinpoint hyperfunctioning parathyroid gland(s). In the majority of patients, ¹⁸F-choline PET/CT was performed after negative or inconclusive findings on ^99mTc-sestamibi SPECT/CT. Pathohistological reports were utilized as the reference standard for evaluating the accuracy of the imaging findings.

Results: The study encompassed 83 patients (70 females, 84.3%) with an average age of 57.2 years (24-80 years). The pathohistological analysis identified a total of 98 glands. In a per-lesion analysis, the detection rate of ^99mTc-sestamibi SPECT/CT was 57% (95% CI 45.3-68.1), while the detection rate of ¹⁸F-choline PET/CT was 90.3% (95% CI 74.3-98.0).

Conclusion: The results of our study showed the significant usefulness of ¹⁸F-choline PET/CT in patients with negative or inconclusive results of ^99mTc-sestamibi SPECT/CT in accurately locating hyperfunctioning parathyroid glands in PHPT patients.