Diagnostic Performance of ^99m Tc-Sestamibi SPECT/CT and ¹⁸ F-Choline PET/CT in Locating Hyperfunctioning Parathyroid Glands in Patients with Primary Hyperparathyroidism

Objective This study aimed to assess the diagnostic performance of Tc-99m-sestamibi SPECT/CT and F-18-choline PET/CT in detecting hyperfunctioning parathyroid glands in patients undergoing surgery for primary hyperparathyroidism (PHPT). Methods A retrospective analysis was conducted on patients who underwent PHPT-related surgery between April 2019 and May 2022. The study focused on patients undergoing either Tc-99m-sestamibi SPECT/CT (81 patients) or F-18-choline PET/CT (33 patients) scans before surgery to pinpoint hyperfunctioning parathyroid gland(s). In the majority of patients, F-18-choline PET/CT was performed after negative or inconclusive findings on Tc-99m-sestamibi SPECT/CT. Pathohistological reports were utilized as the reference standard for evaluating the accuracy of the imaging findings. Results The study encompassed 83 patients (70 females, 84.3%) with an average age of 57.2 years (24-80 years). The pathohistological analysis identified a total of 98 glands. In a per-lesion analysis, the detection rate of Tc-99m-sestamibi SPECT/CT was 57% (95% CI 45.3-68.1), while the detection rate of F-18-choline PET/CT was 90.3% (95% CI 74.3-98.0). Conclusion The results of our study showed the significant usefulness of F-18-choline PET/CT in patients with negative or inconclusive results of Tc-99m-sestamibi SPECT/CT in accurately locating hyperfunctioning parathyroid glands in PHPT patients.