Preoperative Localization of Adenomas in Primary Hyperparathyroidism: The Value of 11 C-Choline PET/CT in Patients with Negative or Discordant Findings on Ultrasonography and 99m Tc-Sestamibi SPECT/CT

J Nucl Med. 2020 Apr;61(4):584-589. doi: 10.2967/jnumed.119.233213. Epub 2019 Oct 10.


We aimed to assess the value of 11C-choline PET in patients with primary hyperparathyroidism and negative or discordant results on 99mTc-sestamibi imaging and neck ultrasound. Methods: Eighty-seven such patients were assessed and subsequently underwent parathyroidectomy. PET/CT image data were analyzed semiquantitatively using SUVmax and SUV ratios (target to contralateral thyroid gland and carotid artery). A positive PET/CT result was defined as focal uptake significantly higher than regular thyroid tissue. Ectopic foci were also considered positive. Inconclusive PET/CT cases were defined as a lesion with uptake equal to normal thyroid tissue. If no prominent or ectopic uptake was detectable, the PET/CT result was considered negative. Results: When dichotomizing the 11C-choline PET/CT imaging results by defining lesions with both positive and inconclusive uptake as positive, we found 84 of 92 lesions (91.3%) to have true-positive uptake whereas 8 lesions (8.7%) had false-positive uptake. One lesion showed false-negative uptake; the sensitivity was 98.8%. The corresponding positive predictive value for lesions was 91.3%. The mean SUVmax was 6.15 ± 4.92 in 72 lesions with positive uptake (70 patients) and 2.96 ± 2.32 in 20 lesions with inconclusive uptake (18 patients). Conclusion: These results in a large group of patients indicate that 11C-choline PET/CT is a promising tool for parathyroid adenoma localization when ultrasound and 99mTc-sestamibi imaging yield negative or discordant results.

Keywords: 11C-choline; PET/CT; primary hyperparathyroidism.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenoma / complications*
  • Adenoma / diagnostic imaging*
  • Adenoma / surgery
  • Carbon Radioisotopes*
  • Choline*
  • Female
  • Humans
  • Hyperparathyroidism, Primary / complications*
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography*
  • Preoperative Period
  • Technetium Tc 99m Sestamibi*
  • Ultrasonography


  • Carbon Radioisotopes
  • Carbon-11
  • Technetium Tc 99m Sestamibi
  • Choline