Usefulness of 18F-Fluorocholine Positron Emission Tomography–Computed Tomography in Locating Lesions in Hyperparathyroidism: A Systematic Review

Importance Identifying parathyroid glands correctly before a surgical procedure is essential to perform minimally invasive surgery. First-line tests with discordant or negative results underscore the need for more accurate imaging tests, thus decreasing the requirement for bilateral neck exploration or reintervention. Objective To review the available evidence to determine positive predictive value, negative predictive value, sensitivity, and specificity in clinical cases in which 18 F-fluorocholine positron emission tomography–computed tomography (PET/CT) could be useful as a method to locate the lesions, and the benefits and controversial aspects of the method. Evidence Review A search was conducted using the PubMed Central and Cochrane Library databases for studies published in English from July 26, 2014, to November 30, 2018, using the search terms 18 choline , 18F choline , 18F-choline , 18 fluorocholine PET CT , hyperparathyroidism , primary hyperparathyroidism , secondary hyperparathyroidism , tertiary hyperparathyroidism , persistent hyperparathyroidism , recurrent hyperparathyroidism , ectopic hyperparathyroidism , and parathyroid adenoma . Other inclusion criteria were reporting at least 1 of the following measurements: negative or positive predictive value, sensitivity, and specificity of 18 F-fluorocholine PET/CT in the diagnosis of hyperparathyroidism (HPT). Exclusion criteria were language other than English, use of a tracer other than 18 F-fluorocholine, reports of a single case, and studies not related to HPT. The Oxford Centre classifications for levels of evidence were used. Findings Sixteen studies fulfilled the inclusion criteria, comprising a total of 619 patients. Selected studies included 10 prospective cohort studies, 5 retrospective cohort studies, and 1 case series. Of the subtypes of HPT diagnosed using 18 F-fluorocholine PET/CT, 579 were primary HPT, 22 were secondary HPT, 1 was tertiary HPT, and 7 were associated with multiple endocrine neoplasia type I. Pathologically, the neoplasms comprised 459 adenomas, 59 hyperplasia, and 19 double adenomas. Conclusions and Relevance 18 F-fluorcholine PET/CT may be indicated when results of first-line tests are negative or discordant and in challenging clinical situations where locating the source of HPT is difficult.