Diagnostic accuracy of choline pet in primary hyperparathyroidism with negative localization studies: a preliminary analysis

Arcenegui Carmen Costas; Gil Sara Hami; Ariza Jimenez Jose Antonio; Jimenez Virginia Hernando; Cuenca Cuenca Juan Ignacio; de Pinillos Gordillo Guillermo Martinez

doi:10.1530/endoabs.110.EP178

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Endocrine Abstracts (2025) 110 EP178 | DOI: 10.1530/endoabs.110.EP178

ECEESPE2025 ePoster Presentations Bone and Mineral Metabolism (142 abstracts)

Diagnostic accuracy of choline pet in primary hyperparathyroidism with negative localization studies: a preliminary analysis

Carmen Costas Arcenegui ¹ , Sara Hami Gil ¹ , Jose Antonio Ariza Jimenez ² , Virginia Hernando Jimenez ¹ , Juan Ignacio Cuenca Cuenca ³ & Guillermo Martinez de Pinillos Gordillo ¹

Author affiliations

¹Hospital Universitario Virgen de Valme, Endocrinology and Nutrition, Sevilla, Spain; ²Hospital Universitario Costa del Sol, Endocrinology and Nutrition, Marbella (Málaga), Spain; ³Hospital Universitario Virgen del Rocio, Nuclear Medicine, Sevilla, Spain

JOINT2310

Introduction: In patients with primary hyperparathyroidism (PHPT), preoperative localization of hyperfunctioning parathyroid glands is essential for proper surgical planning, particularly for minimally invasive procedures. The most used localization techniques include ultrasound, thyroid scintigraphy, and four-dimensional computed tomography (4D-CT). When these conventional imaging modalities yield inconclusive or negative results, choline positron emission tomography (PET) has emerged as a promising alternative for gland localization.

Objective: To describe the baseline characteristics of patients who required choline PET as a localization study for PHPT.

Materials and Methods: This is a preliminary descriptive study including 16 patients diagnosed with PHPT between January 1 and December 31, 2023. The primary aim of this phase was to analyze the baseline characteristics of these patients, with a second phase planned to evaluate the correlation between PET findings and surgical outcomes. Demographic data, biochemical parameters, and imaging results were assessed.

Results: A total of 16 patients were included, of whom 75% were women, with a mean age of 59 ± 14 years. The mean baseline biochemical values were parathyroid hormone (PTH) 119 ± 45 pg/mL (reference range: 15–65 pg/mL), total serum calcium 10.6 ± 0.6 mg/dL, and vitamin D 34 ± 16 ng/mL. Regarding imaging studies, thyroid ultrasound identified a suspicious lesion in 25% of cases, scintigraphy in 20%, and 4D-CT in 28%. In 50% of cases, all conventional imaging techniques were negative, and no complete agreement among the three modalities was observed. Choline PET detected a suggestive lesion in 87.5% of cases. Localization findings on PET were concordant with scintigraphy in 19%, with ultrasound in 19%, and with 4D-CT in 19% of cases.

Conclusions: Choline PET appears to be a promising imaging modality for the localization of hyperfunctioning parathyroid glands in patients with PHPT, particularly when conventional imaging techniques yield negative or inconclusive results. This preliminary study provides a foundation for future research aimed at evaluating the correlation between PET findings and surgical outcomes.