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Use of PET tracers for parathyroid localization: a systematic review and meta-analysis.
Published Web Location
http://download.springer.com/static/pdf/80/art%253A10.1007%252Fs00423-016-1425-0.pdf?originUrl=http://link.springer.com/article/10.1007/s00423-016-1425-0&token2=exp=1487374028~acl=/static/pdf/80/art%25253A10.1007%25252Fs00423-016-1425-0.pdf?originUrl=http%253A%252F%252Flink.springer.com%252Farticle%252F10.1007%252Fs00423-016-1425-0*~hmac=df0fc9aade17aa84171d0e4267fd1d8488c33dbf29283b8500587b99d176a0bdNo data is associated with this publication.
Abstract
Purpose
The great spatial and temporal resolution of positron emission tomography might provide the answer for patients with primary hyperparathyroidism (pHPT) and non-localized parathyroid glands. We performed a systematic review of the evidence regarding all investigated tracers.Methods
A study was considered eligible when the following criteria were met: (1) adults ≥17 years old with non-familial pHPT, (2) evaluation of at least one PET isotope, and (3) post-surgical and pathological diagnosis as the gold standard. Performance was expressed in sensitivity and PPV.Results
Twenty-four papers were included subdivided by radiopharmaceutical: 14 studies investigated L-[11C]Methionine (11C-MET), one [11C]2-hydroxy-N,N,N-trimethylethanamium (11C-CH), six 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG), one 6-[18F] fluoro-L-DOPA (18F-DOPA), and three N-[(18F)Fluoromethyl]-2-hydroxy-N,N-dimethylethanaminium (18F-FCH). The 14 studies investigating MET included a total of 327 patients with 364 lesions. Sensitivity for the detection of a lesion in the correct quadrant had a pooled estimate of 69 % (95 % CI 60-78 %). Heterogeneity was overall high with I2 of 51 % (p = 0.01) for all 14 studies. Pooled PPV ranged from 91 to 100 % with a pooled estimate of 98 % (95 % CI 96-100 %). Of the other investigated tracers, 18-FCH seems the most promising with high diagnostic performance.Conclusions
The results of our meta-analysis show that 11C-MET PET has an overall good sensitivity and PPV and may be considered a reliable second-line imaging modality to enable minimally invasive parathyroidectomy. Our literature review suggests that 18F-FCH PET may produce even greater accuracy and should be further investigated using both low-dose CT and MRI for anatomical correlation.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.