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Our study aims to determine the diagnostic value of\n                      <jats:sup>18<\/jats:sup>\n                      F-fluorocholine positron emission tomography\/magnetic resonance imaging ([\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/MRI) and [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/computed tomography (PET\/CT) in identifying parathyroid adenomas.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective study to assess the diagnostic accuracy of [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/MRI and [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/CT as first- and second-line methods for detecting parathyroid adenomas in patients with pHPT. The primary endpoints included patient-based sensitivity, specificity, and positive predictive value (PPV), with intraoperative surgical localization and histopathological analysis serving as reference, i.e., gold standard.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study included 322 patients. A total of 264 patients underwent [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/MRI, thereof 155 and 109 as a second- and first-line method, respectively. [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/CT was performed in 58 patients, thereof 44 and 14 in a second- and first-line setting, respectively. Total sensitivity, specificity, PPV, negative predictive value (NPV), and diagnostic accuracy of [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/MRI were 0.967, 0.818, 0.983, 0.692, and 0.955, respectively, while the same parameters for [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/CT were 0.980, 0.875, 0.980, 0.875, and 0.966, respectively (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&gt;\u20090.05). There was also no difference between the two methods in the first- or second-line imaging scenarios.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Both [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/MRI and [\n                      <jats:sup>18<\/jats:sup>\n                      F]FCH PET\/CT are highly accurate imaging modalities for localizing parathyroid adenomas in both first- and second-line settings. They can be regarded as \u201ctop-scoring\u201d or \u201cone-stop-shop\u201d techniques for preoperative assessment.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00259-025-07373-1","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T04:45:08Z","timestamp":1748580308000},"page":"5165-5174","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["[18F]Fluorocholine PET\/MRI and [18F]Fluorocholine PET\/CT as first- and second-line imaging in primary hyperparathyroidism \u2013 who takes the lead?"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1946-2128","authenticated-orcid":false,"given":"Petra","family":"Petranovi\u0107 Ov\u010dari\u010dek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Schaab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Beintner-Skawran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Maurer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels J.","family":"Rupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Ikenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9goire B.","family":"Morand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon A.","family":"Mueller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Vetter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Liberini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Giovanella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin W.","family":"Huellner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"7373_CR1","doi-asserted-by":"crossref","unstructured":"Yeh MW, Ituarte PHG, Zhou HC, Nishimoto S, In-Lu Amy Liu, Harari A et al. 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It received ethical approval by the Cantonal Ethics Committee Zurich (BASEC 2022 \u2212\u200901778).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Patients scanned until 2015 were included if they did not refuse the use of their medical data for research. Patients scanned afterward were only included if they consented to the use of their medical data for research.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"The authors affirm that human research participants provided informed consent for the publication of all images in the manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"M.W.H. received grants and speaker honoraria from GE HealthCare, a fund by the Alfred and Annemarie von Sick legacy, and a grant from the clinical research priority program (CRPP) Artificial Intelligence in Oncological Imaging Network of the University of Zurich. N.J.R. discloses an advisory board function for AbbVie AG and receipt of a travel grant from Roche Diagnostics. The other authors have no relevant financial or non-financial interests to disclose.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}