Parathyroid Diseases Clinical Trial
Official title:
Clinical Value of 18F -Fluorocholine (18F-FCH) PET in Localizing Parathyroid Lesions: Comparison With 99mTc-sestamibi (MIBI) Scan.
This prospective study aims to
1. compare the detection rates among sonography, MIBI scan and 18F-FCH PET for localization
of the parathyroid lesions including adenoma, hyperplasia or carcinoma; evaluate the
usefulness of 18F-FCH PET as a second-line tracer in MIBI scan negative patients.
Hyperparathyroidism is a common endocrine disorder. Primary hyperparathyroidism is due to
over-secretion of parathyroid hormone and subsequently hypercalcemia, phyophosphatemia and
osteoporosis, while secondary hyperparathyroidism is due to physiological secretion of
parathyroid hormone by the parathyroid glands in response to hypocalcemia. Surgical approach
is the major treatment modality for majority of these patients with hyperparathyroidism.
Pre-operative localization of hyperfunctioning glands may lead to minimally invasive surgery.
The most commonly used imaging modality for this purpose is 99mTc-sestaMIBI, and supplemented
by ultrasonography of the neck. However, the sensitivity and specificity is significantly
lower in patients with multiple parathyroid lesions.
Recently, some investigators reported cases of parathyroid adenoma discovered incidentally on
choline PET images performed for prostate cancer. 11C or 18F choline is a PET probe used in
imaging prostate cancer and hepatocellular carcinoma. As a phospholipid analog, choline is
integrated into newly synthesized membranes of proliferating cells by up-regulation of
choline kinase. In addition, a previous study showed that the activity of
phospholipid/Ca2+-dependent protein kinase was also higher in hyper-functioning parathyroid
tissue than in atrophic parathyroid gland. Both mechanisms may be responsible for the uptake
of choline tracers in hyperfunctioning parathyroid tissue. Up to now, there are only 3
original reports with limited patients using choline PET in the evaluation of
hyperparathyroidism.
This prospective study aims to
1. compare the detection rates among sonography, MIBI scan and 18F-FCH PET for localization
of the parathyroid lesions including adenoma, hyperplasia or carcinoma;
2. evaluate the usefulness of 18F-FCH PET as a second-line tracer in MIBI scan negative
patients.
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