Biomaterial Database

Multiple endocrine neoplasia type 1 or 4: detection of hyperfunctioning parathyroid glands with 18F-fluorocholine PET/CT. Illustrative cases and pitfalls. 2022

Jean-Noël Talbot, and Jules Zhang-Yin, and Khadoun Kerrou, and Cyrielle Aveline, and Benedicte Vagne, and Ophélie Bélissant, and Marc Tassart, and Sophie Périé, and Phillipe Bouchard, and Sophie Christin-Maitre, and Fabrice Ménégaux, and Lionel Groussin, and Sébastien Gaujoux, and Soňa Balogová, and Françoise Montravers

Department of Nuclear Medicine, Hôpital Tenon AP-HP, Sorbonne University, Paris, France.

18F-fluorocholine (FCH) PET/CT is now well established to detect the hyperfunctioning parathyroid glands (HFPTG) in a case of sporadic primary hyperparathyroidism (pHPT), but only limited evidence is available about the utility of FCH PET/CT to detect the HFPTG in patients with multiple endocrine neoplasia (MEN) type 1 or 4. The pHPT in this context frequently consists in a multiglandular disease with small hyperplastic glands rather than adenomas, which is challenging for imaging modalities. The data of patients with MEN1 or MEN4 after parathyroidectomy referred to FCH PET/CT for presurgical localization of HFPTG were retrospectively reviewed, including follow-up after parathyroidectomy, in search for diagnostic performance and for potential pitfalls. In the present cohort, 16 patients referred to FCH PET/CT as part of their initial pHPT work-up were subsequently operated, 44 abnormal parathyroid glands (PT) were resected, of which 32 (73%) had been detected on FCH PET/CT and 2 considered as equivocal foci. Nine patients referred to FCH PET/CT for recurrent pHPT who were subsequently operated, 14 abnormal PT were resected, all had been detected on FCH PET/CT. FCH PET/CT permitted a unilateral approach for PTx in 4 of them. In one patient with MEN4 and pHPT, the HFPTG could not be visualized on FCH PET/CT but was localized by ultrasonography. Several causes of false positive or false negative results, incidental finding and pitfalls are listed and discussed. FCH PET/CT has a positive benefit/risk ratio in the detection of HFPTG in case of MEN1 (the data in MEN4 being currently very limited) with the most effective detection rate of current imaging modalities for HFPTG, few pitfalls, and an adequate impact on patient management compared to sesta MIBI SPECT and ultrasonography.

UI	MeSH Term	Description	Entries
D010280	Parathyroid Glands	Two pairs of small oval-shaped glands located in the front and the base of the NECK and adjacent to the two lobes of THYROID GLAND. They secrete PARATHYROID HORMONE that regulates the balance of CALCIUM; PHOSPHORUS; and MAGNESIUM in the body.	Gland, Parathyroid,Glands, Parathyroid,Parathyroid Gland
D002794	Choline	A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism.	Bursine,Fagine,Vidine,2-Hydroxy-N,N,N-trimethylethanaminium,Choline Bitartrate,Choline Chloride,Choline Citrate,Choline Hydroxide,Choline O-Sulfate,Bitartrate, Choline,Chloride, Choline,Choline O Sulfate,Citrate, Choline,Hydroxide, Choline,O-Sulfate, Choline
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072078	Positron Emission Tomography Computed Tomography	An imaging technique that combines a POSITRON-EMISSION TOMOGRAPHY (PET) scanner and a CT X RAY scanner. This establishes a precise anatomic localization in the same session.	CT PET,CT PET Scan,PET CT Scan,PET-CT,PET-CT Scan,Positron Emission Tomography-Computed Tomography,CT PET Scans,CT Scan, PET,CT Scans, PET,PET CT Scans,PET Scan, CT,PET Scans, CT,PET-CT Scans,Scan, CT PET,Scan, PET CT,Scan, PET-CT,Scans, CT PET,Scans, PET CT,Scans, PET-CT
D012189	Retrospective Studies	Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.	Retrospective Study,Studies, Retrospective,Study, Retrospective
D017256	Technetium Tc 99m Sestamibi	A technetium imaging agent used to reveal blood-starved cardiac tissue during a heart attack.	99mTc-Hexamibi,99mTc-Sestamibi,Tc MIBI,Cardiolite,Tc-99m-Methoxy-2-isobutylisonitrile,Technetium Tc 99m 2-Methoxy-2-methylpropylisonitrile,Technetium Tc 99m Sestamibi Chloride,Technetium-99m-Hexamibi,Technetium-99m-Sestamibi,99mTc Hexamibi,99mTc Sestamibi,Tc 99m Methoxy 2 isobutylisonitrile,Technetium 99m Hexamibi,Technetium 99m Sestamibi,Technetium Tc 99m 2 Methoxy 2 methylpropylisonitrile
D049950	Hyperparathyroidism, Primary	A condition of abnormally elevated output of PARATHYROID HORMONE due to parathyroid HYPERPLASIA or PARATHYROID NEOPLASMS. It is characterized by the combination of HYPERCALCEMIA, phosphaturia, elevated renal 1,25-DIHYDROXYVITAMIN D3 synthesis, and increased BONE RESORPTION.	Primary Hyperparathyroidism,Hyperparathyroidisms, Primary,Primary Hyperparathyroidisms
D018761	Multiple Endocrine Neoplasia Type 1	A form of multiple endocrine neoplasia that is characterized by the combined occurrence of tumors in the PARATHYROID GLANDS, the PITUITARY GLAND, and the PANCREATIC ISLETS. The resulting clinical signs include HYPERPARATHYROIDISM; HYPERCALCEMIA; HYPERPROLACTINEMIA; CUSHING DISEASE; GASTRINOMA; and ZOLLINGER-ELLISON SYNDROME. This disease is due to loss-of-function of the MEN1 gene, a tumor suppressor gene (GENES, TUMOR SUPPRESSOR) on CHROMOSOME 11 (Locus: 11q13).	Neoplasia, Multiple Endocrine Type 1,Neoplasms, Multiple Endocrine Type 1,Wermer Syndrome,Multiple Endocrine Neoplasia Type I,Multiple Endocrine Neoplasms Type 1,Neoplasms, Multiple Endocrine Type I