The Value Of ¹¹C-choline PET/CT In The Diagnosis Of Primary Hyperparathyroidism

Objective:To evaluate the different imaging localization efficacy of patients with primary hyperparathyroidism before operation,especially the comparison of localization efficacy of new imaging ¹¹C-choline PET/CT and traditional imaging examination,and to analyze the influencing factors of ¹¹C-choline PET/CT and traditional imaging examination.Methods:This study included the clinical data of 32 patients with primary hyperparathyroidism（PHPT）who were treated in the Department of Nuclear Medicine of the Sino-Japanese Friendship Hospital of Jilin University from January 2019 to December 2022 and underwent surgical treatment in the Department of Thyroid Surgery of our hospital,and have completed ¹¹C-choline PET/CT examination in our department.The sensitivity,specificity,positive predictive value and negative predictive value of each imaging examination were calculated based on the postoperative pathological diagnosis as the gold standard to compare the positioning efficiency of different imaging methods,and to analyze the factors affecting the results of the new imaging ¹¹C-choline PET/CT and the traditional imaging examination.Results:1.From January 2019 to December 2022,32 patients were included in the analysis.Among them,5 males and 27 females,with an average age of 49.5±14.7 years,body mass index（BMI）of 23.09±3.14 kg/m2,4 smokers,5 drinkers,preoperative blood calcium level of 2.78（2.00,3.38）mmol/L,preoperative PTH level of 274.70（93.87931.40）pg/ml,maximum diameter of the lesion 29.0（6.7,29.0）mm,30 patients with single gland lesion resection and 2 patients with multiple gland lesion resection.2.In the patients undergoing ¹¹C-choline PET/CT examination,based on the analysis of each lesion,30 glands were classified as true positive,3 glands were classified as false positive,91 glands were classified as true negative,and 4 glands were classified as false negative.The sensitivity,specificity,positive predictive value and negative predictive value of ¹¹C-choline PET/CT were 88.2%,96.8%,90.9%and 95.7%respectively.The ROC curve of SUVmax in the study sample was analyzed,and the cut-off value of ¹¹C-choline PET/CT in diagnosing PHPT was 4.57.The sensitivity of neck ultrasound,^99mTc-MIBI dual-phase plane imaging and ^99mTc-MIBI SPECT/CT were 52.9%,58.8%and 67.6%,respectively,the specificity was 95.7%,96.8%and 95.7%,the positive predictive value was 81.8%,86.9%and 85.2%,and the negative predictive value was84.9%,86.7%and 89.1%,respectively.3.According to the results of ^99mTc-MIBI SPECT/CT imaging,we divided them into ^99mTc-MIBI SPECT/CT imaging positive group and negative group.Through inter-group comparison,we found that there was no statistical difference in preoperative blood calcium and PTH values between the two groups on ^99mTc-MIBI SPECT/CT imaging（P>0.05）,while the difference in the maximum diameter of the lesion was statistically significant（P<0.05）.Conclusion:¹¹C-Choline PET/CT is superior to conventional imaging examinations in the preoperative diagnosis of primary hyperparathyroidism(neck ultrasound,^99mTc-MIBI dual-phase plane imaging,^99mTc-MIBI SPECT/CT).