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Endocrine Abstracts (2015) 38 OC5.3 | DOI: 10.1530/endoabs.38.OC5.3

Thyroid and parathyroid

Use of 11C-methionine PET to localise parathyroid adenoma/hyperplasia: a single centre experience

Ben Challis2, Ziauddin Saad1, H K Cheow1, John Buscombe1 & Helen Simpson1

1Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; 2University of Cambridge, Cambridge, UK.

Introduction: It is established practice to localise parathyroid lesions preoperatively using ultrasound (US) and sestaMIBI (MIBI). Whilst these imaging techniques have good sensitivity/specify, there are patients in which imaging does not localise a parathyroid lesion. 11C-Methionine PET (MET PET) is an imaging modality where 11C-methionine, a radioactive tracer, is taken up at sites of protein/peptide synthesis and has been demonstrated to be effective in localising parathyroid lesions. We therefore investigated the clinical utility of this imaging technique at our centre.

Methods: All patients had biochemistry prior to imaging thought to be consistent with primary hyperparathyroidism. Criteria to undergo PET imaging were inability of conventional imaging to identify a parathyroid lesion, potential intrathyroidal parathyroid lesion, and three patients where mediastinal disease was suspected. Twenty patients underwent MET PET over an 18-month period.

Results: MET PET identified a parathyroid lesion in 14/20 patients. Three out of three of these were demonstrated to be mediastinal lesions, leading to a parathyroid adenoma being successfully resected by sternotomy. 11/20 demonstrated disease in the neck. Of these 3/11 parathyroid lesions were very deep in the neck adjacent to vertebrae/oesophagus and not seen with US/sestaMIBI. In 2/11 patients MET PET demonstrated intrathyroidal parathyroid lesions and patients underwent hemithyroidectomy. All parathyroid lesions were confirmed on histology (13 adenoma and one hyperplasia). Of the 6/20 who had negative imaging, one now has a diagnosis of sarcoidosis with elevated 1,25-dihydroxycholecalciferol, one underwent bilateral neck exploration and histology demonstrated parathyroid hyperplasia. The remaining four patients are still being investigated with working diagnoses of FHH in three patients.

Discussion: MET PET is a useful additional functional imaging technique when conventional imaging fails to localise a lesion, where mediastinal disease is suspected or intrathyroidal disease needs confirmation. This can particularly helpful when deciding to refer patients for major surgery.

Volume 38

Society for Endocrinology BES 2015

Edinburgh, UK
02 Nov 2015 - 04 Nov 2015

Society for Endocrinology 

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