Refining the role of presurgical PET/4D‐CT in a large series of patients with primary hyperparathyroidism undergoing [18F]Fluorocholine PET/CT
Year: 2024
Type: article
Study design: Observational Study
Abstract: Background 4D‐CT has garnered attention as complementary imaging for patients with primary hyperparathyroidism (pHPT). Herein we evaluated a diagnostic strategy using [18F]Fluorocholine Positron Emission Tomography/Computed Tomography (PET/CT), followed by 4D‐CT integrated into PET/4D‐CT after negative/inconclusive PET/CT results in a single‐center retrospective cohort of 166 pHPT patients who underwent parathyroidectomy after [18F]Fluorocholine PET/4D‐CT. Methods PET/CT and 4D‐CT images were interpreted by three nuclear medicine physicians and one expert radiologist. Pathological findings were documented, and concordance rates were assessed. PET/CT results were categorized as positive/negative, with positive cases rated on a 3‐level certitude scale: low, moderate, high. Inconclusive cases included low/moderate positivity. The added value of PET/4D‐CT was assessed for negative/inconclusive cases through joint reading. Results PET/CT lesion‐based analysis showed almost perfect interobserver concordance (Cohen's kappa >.8). Across the cohort, PET/CT had a sensitivity of 83%, specificity of 97%, PPV of 90% and NPV of 94%. For 4D‐CT, these values were sensitivity: 53%, specificity: 84%, PPV: 56% and NPV: 82%. PET/CT was significantly more accurate than 4D‐CT. Among 44 patients with negative/inconclusive results, PET/CT had sensitivity: 60%, specificity: 91%, PPV: 71% and NPV: 86%. In the same patients, sensitivity and specificity of the sequential diagnostic algorithm increased to 80% and 97%, showing significantly better global accuracy (92% vs. 83%) than standard PET/CT. Conclusions We support a personalized imaging algorithm for pHPT, placing [18F]Fluorocholine PET/CT at the forefront, followed by 4D‐CT integrated into PET/4D‐CT in the same imaging session for negative/inconclusive results. When PET/CT results are clearly positive, the additional sensitivity benefit of 4D‐CT is minimal.
DOI: 10.1111/eci.14336
Institutions: Institut de Cancérologie Strasbourg, University of Jeddah, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, University of Hassan II Casablanca, Ente Ospedaliero Cantonale, Istituto Imaging della Svizzera Italiana, Università della Svizzera italiana, University of Lausanne, Ospedale regionale di Lugano, Institut de Recherche contre les Cancers de l’Appareil Digestif, Institut de Chirurgie Guidée par l'Image, Ente Ospedaliero Ospedali Galliera, Centre National de la Recherche Scientifique, Institut Pluridisciplinaire Hubert Curien
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,900
OpenAlex ID: W4403360099