18F-Fluorocholine PET–CT enables minimal invasive parathyroidectomy in patients with negative sestamibi SPECT–CT and ultrasound: A case report. (2015)

• Record Type: Journal Article
• Authors: Kluijfhout, Wouter P.; Vriens, Menno R.; Valk, Gerlof D.; Barth, Roos E.; Borel Rinkes, Inne H.M.; de Keizer, Bart
• Is Part Of: International journal of surgery case reports. Volume 13(2015)
• Page Start: 73
• Page End: 75
• Publication Date: 2015
• Subjects: pHPT primary hyperparathyroidism -- MIP minimal invasive parathyroidectomy -- BNE bilateral neck exploration -- Ca calcium -- PTH parathormone -- SPECT single photon emission computed tomography -- CT computed tomography -- PET positron emission tomography -- FCH 18F-fluorocholine -- US ultrasound; Primary hyperparathyroidism -- Minimal invasive parathyroidectomy -- Parathyroid adenoma -- 18F-Fluorocholine PET–CT; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2015.06.012
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Preoperative imaging is essential for minimal invasive parathyroidectomy. Conventional imaging is often negative or inconclusive. 18 F-Fluorocholine PET–CT might be a solution. We describe a patient with negative SPECT–CT and ultrasound. Patient underwent successful surgery after positive PET–CT. Abstract: Introduction: Primary hyperparathyroidism is a common endocrine disorder for which the primary treatment is surgery. For minimal invasive parathyroidectomy adequate pre-operative imaging is essential. Conventional imaging is often inconclusive. There are reports that 18 F-fluorocholine PET–CT might be a superior imaging modality, however evidence is still very scarce. This is the first report of a case with negative ultrasound and sestamibi SPECT–CT imaging that underwent successful minimal invasive surgery because of 18 F-fluorocholine PET–CT. Presentation of case: A 57 year-old man presented to us with complaints of fatigue. Laboratory results showed a biochemical primary hyperparathyroidism and an additional DEXA-scan revealed osteopenia of the lumbar spine. Conventional imaging consisting of neck ultrasound and Tc-99m-sestamibi SPECT–CT was however unable to localize the pathological gland. Subsequent 18 F-fluorocholine PET–CT did clearly localize an adenoma dorsally of the left thyroid lobe which was removed at that exact location using minimal invasive parathyroidectomy. Histological examination confirmed the diagnosis adenoma and calcium levels remained normal at follow-up. Discussion: There is clinical need for a superior imaging modality to detect pathological parathyroid glands to enable minimal invasive surgery. 18 F-Fluorocholine is widely available. Conclusion: 18 F-Fluorocholine PET–CT is a promising new imaging modality for localizing parathyroid adenomas and enabling minimal invasive parathyroidectomy when conventional imaging fails to do. Clinicians should consider its use as a second line modality for optimal patient care.