Optimal scan time for evaluation of parathyroid adenoma with [(18)F]-fluorocholine PET/CT

Sebastijan Rep, Luka Lezaic, Tomaz Kocjan, Marija Pfeifer, Mojca Jensterle Sever, Urban Simoncic, Petra Tomse, Marko Hocevar, Sebastijan Rep, Luka Lezaic, Tomaz Kocjan, Marija Pfeifer, Mojca Jensterle Sever, Urban Simoncic, Petra Tomse, Marko Hocevar

Abstract

Background: Parathyroid adenomas, the most common cause of primary hyperparathyroidism, are benign tumours which autonomously produce and secrete parathyroid hormone. [(18)F]-fluorocholine (FCH), PET marker of cellular proliferation, was recently demonstrated to accumulate in lesions representing enlarged parathyroid tissue; however, the optimal time to perform FCH PET/CT after FCH administration is not known. The aim of this study was to determine the optimal scan time of FCH PET/CT in patients with primary hyperparathyroidism.

Patients and methods: 43 patients with primary hyperparathyroidism were enrolled in this study. A triple-phase PET/CT imaging was performed five minutes, one and two hours after the administration of FCH. Regions of interest (ROI) were placed in lesions representing enlarged parathyroid tissue and thyroid tissue. Standardized uptake value (SUVmean), retention index and lesion contrast for parathyroid and thyroid tissue were calculated.

Results: Accumulation of FCH was higher in lesions representing enlarged parathyroid tissue in comparison to the thyroid tissue with significantly higher SUVmean in the second and in the third phase (p < 0.0001). Average retention index decreased significantly between the first and the second phase and increased significantly between the second and the third phase in lesions representing enlarged parathyroid tissue and decreased significantly over all three phases in thyroid tissue (p< 0.0001). The lesion contrast of lesions representing enlarged parathyroid tissue and thyroid tissue was significantly better in the second and the third phase compared to the first phase (p < 0.05).

Conclusions: According to the results the optimal scan time of FCH PET/CT for localization of lesions representing enlarged parathyroid tissue is one hour after administration of the FCH.

Keywords: [18F]-fluorocholine PET/CT; lesion contrast; lesions representing enlarged parathyroid tissue; retention index; standardized up-take value; triple-phase.

Figures

FIGURE 1.
FIGURE 1.
Different SUVmean in all three phases of the described kinetics of FCH in LREPT and thyroid tissue.
FIGURE 2.
FIGURE 2.
Retention index (RI) between the second and the third phase (RI23) versus RI between the first and the second phase (RI12) for all LREPT (A), and for thyroid tissue (B). Positive (negative) values of both RI12 and RI23 represent SUVmean increase (decrease) through different phases; whereas positive (negative) RI12 and negative (positive) RI23 represent an increase (decrease) of SUVmean after the first phase, followed by a decrease (increase) after the second phase.
FIGURE 3.
FIGURE 3.
(A) The number of lesions in ranges of lesion contrast (LC) values for all three phases; for both positive and negative LC. (B) The number of both positive and negative lesions having absolute LC value equal or greater to the value on horizontal axis.
FIGURE 4.
FIGURE 4.
A secluded lower left LREPT. FCH PET/CT was performed in triple-phase after administration of 100 MBq of FCH. The LREPT is well delineated according to the thyroid tissue on PET axial image in the first (A1), the second (A2) and the third phase (A3). SUVmean in the LREPT and the thyroid tissue was in the first phase 6.3 and 3.6, in the second phase 7.1 and 3, and in the third phase 6.6 and 2.9. The CT axial image of the LREPT and the thyroid tissue in all three phases (B1, B2, B3), and the FCH PET/CT axial fusion image in all three phases (C1, C2, C3).

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Source: PubMed

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