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Endocrine Abstracts (2017) 49 GP50 | DOI: 10.1530/endoabs.49.GP50

ECE2017 Guided Posters Bone & Calcium Homeostasis 2 (9 abstracts)

Localisation of parathyroid adenomas using 11C-methionine-PET/CT when conventional imaging methods are negative

Lassi Nelimarkka 1, , Aapo Ounaslehto 7 , Eija Eloranta 4 , Leena Moilanen 5 , Saija Hurme 3 , Marko Seppänen 2, & Pirjo Nuutila 1,


1Turku University Hospital, Department of Medicine, Division of Endocrinology, Turku, Finland; 2Turku PET Centre, Turku University Hospital, Turku, Finland; 3Department of Biostatistics, University of Turku, Turku, Finland; 4Department of Medicine, Division of Medicine and Pulmonary Diseases, Oulu University Hospital, Oulu, Finland; 5Division of Endocrinology, Department of Medicine, Kuopio University Hospital, Kuopio, Finland; 6Department of Nuclear Medicine, Turku University Hospital, Turku, Finland; 7Department of Medicine, University of Turku, Turku, Finland.


In primary hyperparathyroidism (pHPT) an exact localization of the pathological parathyroid gland(s) is essential before minimally invasive parathyroidectomy. We have previously shown in a small group of pHPT patients, that 11C-methionine-PET/CT provides additional information if 123I/99m Tc-sestamibi (MIBI) scan remains negative. The aim of the present study was to evaluate the clinical value of 11C-Met-PET/CT in a larger pHPT patient cohort.

Methods: Totally 89 patients with pHPT (66 females, 23 males, age 18-81 years) and negative or inconclusive localisation findings with 123I/99mTc- MIBI-SPECT/CT (78,7%) or 99mTc-MIBI-SPECT/CT (21.3%) were studied with 11C-Met-PET/CT. Most of the patients (87.6%) were surgical treatment naive and the rest of them (12.4%) were previously operated 1–2 times.

Results: 11C-Met-PET/CT revealed the pathologic parathyroid gland in 48 (60.8%) of the 79 surgically treated patients. Totally 26 patients (32.9%) had a negative 11C-Met-PET/CT finding and 16 of them had further explorative surgery, whereas 10 of these Met-PET negative patients were not operated, but treated conservatively instead. In five cases (6.3%) Met-PET detected a false-positive finding, i.e. the pathological parathyroid gland was found in another location. On a per-lesion level PET results were 48 true positive (60.8%) and 21 false negative (26.6%). The lesion-based sensitivity was 75.4% (positive predictive value 94.6%) and specificity 40.0% (negative predictive value 10.5%). The diagnostic accuracy of 11C-Met-PET/CT in this study was 73%. Based on the histological examinations 67 adenomas (84.8%) and six hyperplastic (7.6%) parathyroid glands were found. In five cases the finding was normal parathyroid tissue or unspecified. Ten patients (12.7%) had more than one pathological parathyroid glands. There were no parathyroid carcinomas detected in this study. Totally 79 patients had parathyroid surgery and 55 (69.6%) of them were biochemically cured, but in 16 patients (20.3%) pHPT persisted and in eight patients (10.1%) the postoperative status remained unknown.

Conclusion: 11C-methionine-PET/CT offers an additional noninvasive imaging method to localize hyperfunctiong parathyroid glands in a situation when conventional imaging methods 99mTc or 123I/99mTc-sestamibi SPECT/CT fail or are equivocal.

Volume 49

19th European Congress of Endocrinology

Lisbon, Portugal
20 May 2017 - 23 May 2017

European Society of Endocrinology 

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