Superior performance of 18F-fluorocholine digital PET/CT in the detection of parathyroid adenomas

Diego Alfonso López-Mora*, Marina Sizova, Montserrat Estorch, Albert Flotats, Valle Camacho, Alejandro Fernández, Safae Abouzian, Francisco Fuentes-Ocampo, José Ignacio Pérez Garcia, Ana Isabel Chico Ballesteros, Joan Duch, Anna Domènech, Antonio Moral Duarte, Ignasi Carrió

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

23 Citations (Scopus)


Objective: To compare detectability of hyperfunctioning parathyroid tissue (HPT) by digital and analog 18F-fluorocholine PET/CT in patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT. Materials and methods: Thirty-three patients with primary hyperparathyroidism and negative/inconclusive 99mTc-MIBI scintigraphy-SPECT/CT were prospectively included. All patients accepted to be scanned by digital and analog PET/CT in the same imaging session after a single injection of 18F-fluorocholine. Three nuclear medicine physicians evaluated the digital and analog PET/CT datasets to assess the detection rate of HPT. Maximum standard uptake values (SUVmax) of HPT and locoregional lymph nodes were measured in both systems. Results: HPT was detected in 30/33 patients by the digital system, whereas it was detected in 22/33 patients by the analog system (p < 0.01). Moreover, in 21 of these 33 patients, both systems detected one focal 18F-fluorocholine uptake, and in one patient the digital system detected two foci. Histopathology demonstrated HPT in 32 patients and it was inconclusive in one patient. The digital PET/CT detected HPT in 29 of the 32 patients, and the analog system in 22 of the 32 (p < 0.01). All HPT suspected lesions resected and detected only by the digital system (n = 8) were < 10 mm (7.5 ± 1.3 mm), while those detected by both systems (n = 22) were > 10 mm (13 ± 3.8 mm). SUVmax of HPT lesions was significantly higher than SUVmax of locoregional lymph node independently of the PET/CT system used (4.5 ± 1.9 vs. 2.9 ± 1.3, p < 0.0001). Conclusions: Digital PET/CT offers superior performance over analog system in patients with suspected HPT and previous negative/inconclusive imaging examinations, particularly in sub-centimeter lesions. SUVmax can help in the differentiation between HTP and locoregional lymph nodes.

Original languageEnglish
Pages (from-to)572-578
Number of pages7
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number3
Publication statusPublished - 1 Mar 2020


  • 18F-fluorocholine
  • 99mTc-MIBI scintigraphy
  • Analog PET/CT
  • Digital PET/CT
  • Parathyroid adenoma
  • Primary hyperparathyroidism


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