Dynamic 18F-fluorocholine PET/CT for parathyroid imaging in patients with primary hyperparathyroidism

Nucl Med Commun. 2020 Aug;41(8):776-782. doi: 10.1097/MNM.0000000000001217.


Objective: In the past few years, F-fluorocholine PET/CT has been established as a promising imaging technique for preoperative localization of parathyroid adenomas, but the optimal time point to start PET/CT acquisition after tracer injection is yet unknown. The aim of the present study was to assess the optimal time frame to acquire the PET/CT images and to evaluate the ability of dynamic imaging to differentiate parathyroid adenomas from active lymph nodes, a common cause for false-positive scan results.

Patients and methods: Patients with primary hyperparathyroidism who had undergone a dynamic F-fluorocholine PET/CT positive for parathyroid disease and who subsequently underwent successful parathyroidectomy were retrospectively included in this study. On the 20 minutes dynamic images, standardized uptake value measurements were acquired per 1 minute frame for the parathyroid adenoma, the thyroid gland, blood pool activity, and, if present, lymph node activity.

Results: A total of 101 patients were included in this study. Time-activity curves showed a decrease of activity in parathyroid and thyroid glands, with faster wash-out from the thyroid gland and on average a stable, lower activity in lymph nodes. Blood pool activity was particularly present in the first 2 minutes. Differentiation of a parathyroid adenoma from active lymph nodes was best before 5 minutes, but no definitive cutoff value could be determined. Differentiation of a parathyroid adenoma from the thyroid gland was best after 10 minutes.

Conclusion: Dynamic imaging starting at the early time point of 2 minutes after injection of F-fluorocholine is useful for characterization of hyperfunctioning parathyroid glands.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Choline / analogs & derivatives*
  • Diagnosis, Differential
  • Female
  • Humans
  • Hyperparathyroidism, Primary / diagnostic imaging*
  • Image Processing, Computer-Assisted
  • Male
  • Middle Aged
  • Parathyroid Glands / diagnostic imaging*
  • Parathyroid Neoplasms / diagnostic imaging
  • Positron Emission Tomography Computed Tomography*
  • Retrospective Studies


  • fluoromethylcholine
  • Choline