Assessing the effectiveness of 18F-Fluorocholine PET-CT as the leading imaging technique compared to 99mTc-Sestamibi scans and ultrasonography for diagnosing hyperparathyroidism.

BACKGROUND: Accurate preoperative localization of hyperfunctioning parathyroid tissue is paramount for the success of minimally invasive parathyroidectomy in primary hyperparathyroidism (PHPT). Conventional imaging with 99mTc-sestamibi (MIBI) scintigraphy and cervical ultrasonography (US) has significant limitations in sensitivity and specificity. This study aims to evaluate the diagnostic performance of 18F-fluorocholine PET/CT (FCH-PET/CT) as a preferred imaging modality compared with conventional methods. METHOD: ology: A prospective, non-interventional cohort study was conducted on 82 patients with biochemically proven PHPT who underwent preoperative localization with US, MIBI-SPECT/CT, and FCH-PET/CT between January 2022 and January 2025. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and detection rates of each modality were calculated, with histopathology and clinical follow-up serving as the reference standard. RESULTS: FCH-PET/CT demonstrated significantly higher sensitivity (84.1% vs. 36.6%) and detection rate (85.4% vs. 30.5%) compared to MIBI. Ultrasonography showed lower performance metrics than FCH and higher than MIBI except NPV% for the latter. In 41 cases (50%) where MIBI was negative or equivocal, FCH-PET/CT correctly localized hyperfunctioning tissue in 36 cases (87.8%), including cases of multi-glandular disease, ectopic adenomas, and post-surgical recurrence. The specificity and PPV for FCH-PET/CT were also superior, confirming its reliability in identifying true positives. CONCLUSION: 18F-fluorocholine PET/CT is a significantly more effective imaging technique for preoperative parathyroid localization than conventional MIBI scintigraphy and ultrasonography. Its implementation, particularly in cases with negative, equivocal, or discordant conventional imaging, can drastically improve surgical planning, minimize operative failure and reoperation rates, and enhance patient outcomes in PHPT.