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CC BY-NC-ND 4.0 · World J Nucl Med 2022; 21(03): 192-199
DOI: 10.1055/s-0042-1751031
Original Article

Incidental Findings on 18F-Fluorocholine PET/CT for Parathyroid Imaging

Wouter A.M. Broos
1   Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
2   CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
,
Remco J.J. Knol
1   Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
,
Friso M. van der Zant
1   Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
,
Nicolaas C. Schaper
2   CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
3   Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
,
Maurits Wondergem
1   Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
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Abstract

Introduction 18F-choline positron emission tomography/computed tomography (PET/CT) is an upcoming imaging technique for the localization of hyperfunctioning parathyroid glands. However, 18F-choline is a nonspecific tracer that also accumulates in malignancies, inflammatory lesions, and several other benign abnormalities. The aim of this study was to determine the occurrence and relevance of incidental findings on 18F-choline PET/CT for parathyroid localization.

Materials and Methods 18F-choline PET/CTs performed in our center for parathyroid localization from 2015 to 2019 were reviewed. Abnormal uptake of 18F-choline, with or without anatomical substrate on the co-registered low-dose CT and also incidental findings on CT without increased 18F-choline uptake were recorded. Each finding was correlated with follow-up data from the electronic medical records.

Results A total of 388 18F-choline PET/CTs were reviewed, with 247 incidental findings detected in 226 patients (58%): 82 18F-choline positive findings with corresponding pathology on CT, 16 without CT substrate, and 149 18F-choline negative abnormalities on CT. Malignant lesions were detected in 10/388 patients (2.6%). Of all 98 detected 18F-choline positive lesions, 15 were malignant (15.3%), concerning 4 metastases and 11 primary malignancies: breast carcinoma (n = 7), lung carcinoma (n = 2), thyroid carcinoma (n = 1), and skin melanoma (n = 1).

Conclusion Clinically relevant incidental findings were observed in a substantial number of patients. In 15.3% of the incidental 18F-choline positive findings, the lesions were malignant. These data contribute to better knowledge of 18F-choline distribution, enhance interpretation of 18F-choline PET/CT, and guide follow-up of incidental findings. Attention should especially be paid to breast lesions in this particular patient group with hyperparathyroidism in which women are typically over-represented.

Keywords

18F-fluorocholine - PET/CT - hyperparathyroidism - incidental findings

Informed Consent

All patients gave written informed consent for the use of their anonymized data for scientific purposes. Besides the standard imaging protocol and clinical management, no additional measurements or actions affecting the patient were performed. The study was approved by the institutional research department and performed in accordance with the Declaration of Helsinki. Approval of the local ethical committee for the present study was not necessary since the study does not fall within the scope of the Dutch Medical Research Involving Human Subjects Act (section 1.b WMO, 26th February 1998).




Publication History

Article published online:
16 August 2022

© 2022. World Association of Radiopharmaceutical and Molecular Therapy (WARMTH). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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