A lesion-based comparison of F-18 Fluorocholine PET and dual-phase Tc-99m sestamibi imaging in patients with secondary/tertiary hyperparathyroidism undergone pre-operative gland localization

1089 Objectives: F-18 Fluorocholine (F-18 FCH) PET is more sensitive for localizing parathyroid adenoma in primary hyperparathyroidism compared to Tc-99m sestamibi scintigraphy. However, in secondary/tertiary hyperparathyroidism, the comparison of F-18 FCH PET to Tc-99m sestamibi imaging has not been made. Methods: We conducted a prospective study comparing F-18 FCH PET and dual phase Tc-99m sestamibi imaging. A local ethical committee has approved our research, and all enrolled subjects have given their written consents. We enrolled patients with a diagnosis of secondary or tertiary hyperparathyroidism and the patient underwent both dual-phase Tc-99m sestamibi scan and F-18 FCH PET. Then they underwent parathyroidectomy and the standard of truth was pathological results. We compare sensitivity, specificity and accuracy of both image tools. McNemar’s Chi-Square test was used to examine the statistical significance with a p-value < 0.05 as significant. Results: We enrolled 16 patients and analyzed 59 glandular sites. The lesion based sensitivity of F-18 FCH PET and Tc-99m sestamibi scan were 72% and 48%, respectively (p = 0.002). The specificity of F-18 FCH PET and Tc-99m sestamibi scan were 77.8% and 88.9%, respectively (non-statistically significant). The accuracy of F-18 FCH PET and Tc-99m sestamibi scan were 72.73% and 56.36%, respectively (p = 0.001). Among the 16 patients, F-18 FCH PET accurately identified more hyperplastic parathyroid glands in 7 patients (44%). Conclusions: In patients with secondary/tertiary hyperparathyroidism, F-18 FCH PET is significantly more sensitive and may supplant dual phase Tc-99m sestamibi scan for pre-operative localizing hyperfunctional glands.