18F-Fluorocholine PET/CT and Parathyroid 4D Computed Tomography for Primary Hyperparathyroidism: The Challenge of Reoperative Patients

World J Surg. 2019 May;43(5):1232-1242. doi: 10.1007/s00268-019-04910-6.


Background: To evaluate FCH-PET/CT and parathyroid 4D-CT so as to guide surgery in patients with primary hyperparathyroidism (pHPT) and prior neck surgery.

Methods: Medical records of all patients referred for a FCH-PET/CT in our institution were systematically reviewed. Only patients with pHPT, a history of neck surgery (for pHPT or another reason) and an indication of reoperation were included. All patients had parathyroid ultrasound (US) and Tc-99m-sestaMIBI scintigraphy, and furthermore, some patients had 4D-CT. Gold standard was defined by pathological findings and/or US-guided fine-needle aspiration with PTH level measurement in the washing liquid.

Results: Twenty-nine patients were included in this retrospective study. FCH-PET/CT identified 34 abnormal foci including 19 ectopic localizations. 4D-CT, performed in 20 patients, detected 11 abnormal glands at first reading and 6 more under FCH-PET/CT guidance. US and Tc-99m-sestaMIBI found concordant foci in 8/29 patients. Gold standard was obtained for 32 abnormal FCH-PET/CT foci in 27 patients. On a per-lesion analysis, sensitivity, specificity, positive and negative predictive values were, respectively, 96%, 13%, 77% and 50% for FCH-PET/CT, 75%, 40%, 80% and 33% for 4D-CT. On a per-patient analysis, sensitivity was 85% for FCH-PET/CT and 63% for 4D-CT. FCH-PET/CT results made it possible to successfully remove an abnormal gland in 21 patients, including 12 with a negative or discordant US/Tc-99m-sestaMIBI scintigraphy result, with a global cure rate of 73%.

Conclusion: FCH-PET/CT is a promising tool in the challenging population of reoperative patients with pHPT. Parathyroid 4D-CT appears as a confirmatory imaging modality.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Aged
  • Choline / analogs & derivatives
  • Female
  • Four-Dimensional Computed Tomography / methods
  • Humans
  • Hyperparathyroidism, Primary / diagnostic imaging*
  • Hyperparathyroidism, Primary / surgery*
  • Image-Guided Biopsy / methods
  • Male
  • Middle Aged
  • Neck / surgery
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Glands / surgery*
  • Parathyroid Hormone / analysis
  • Positron Emission Tomography Computed Tomography / methods
  • Radionuclide Imaging / methods
  • Reoperation / methods
  • Retrospective Studies
  • Sensitivity and Specificity
  • Technetium Tc 99m Sestamibi
  • Ultrasonography, Interventional / methods
  • Young Adult


  • Parathyroid Hormone
  • fluorocholine
  • Technetium Tc 99m Sestamibi
  • Choline