Accuracy of 18F-fluorocholine PET for the detection of parathyroid adenomas: prospective single center study.

Purpose: The purpose of this prospective study was to determine the correct localization rate (CLR) of 18F-fluorocholine (FCH) positron emission tomography (PET) for the detection of parathyroid adenomas in comparison to sestamibi imaging. Materials and Methods: This was a single-arm prospective trial. Ninety-eight patients with biochemical evidence of primary hyperparathyroidism were imaged prior to parathyroidectomy using FCH PET/MRI. Sestamibi imaging performed separately from the study was evaluated for comparison. The primary endpoint of the study was the CLR on a patient level. Each imaging study was interpreted by 3 blinded readers on a per-region basis. Lesions were validated by histopathologic analysis of surgical specimens. Results: Of the 98 patients who underwent FCH imaging, 77 subsequently underwent parathyroidectomy and 60 of those had sestamibi imaging. The CLR for FCH in patients who underwent parathyroidectomy based on the blinded reader consensus was 75% [0.63, 0.82]. In patients who underwent surgery and had an available sestamibi study, the CLR increased from 17% [0.10, 0.27] for sestamibi to 70% [0.59, 0.79] for FCH PET. Conclusion: In this prospective study using blinded readers, the CLR for FCH was 75%. In patients with paired sestamibi, the use of FCH PET increased the CLR from 17% to 70%. FCH PET is a superior imaging modality for the localization of parathyroid adenomas.