{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T21:50:27Z","timestamp":1790977827084,"version":"4.1.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T00:00:00Z","timestamp":1754092800000},"content-version":"vor","delay-in-days":32,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Accurate preoperative localization is essential for successful, focused, minimally invasive surgery in primary hyperparathyroidism (PHPT). New imaging techniques have recently been proposed. This study evaluated the impact of 18F-choline positron emission tomography (PET)\u2013computed tomography or 18F-choline PET\u2013magnetic resonance imaging (FCh) in patients with negative or inconclusive results on neck ultrasonography (US) and 99mTc-sestamibi (MIBI) scintigraphy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Baseline biochemical characteristics (preoperative calcemia and PTH), parathyroid gland features (size and weight), preoperative imaging localization techniques accuracy, and surgical results were compared in a series of patients operated for PHPT who underwent only preoperative US and MIBI scintigraphy with concordant results (MIBI Group) or also FCh as additional imaging following US and MIBI with negative or inconclusive results (FCh Group).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The overall cure rate was 100% in 185 patients operated for PHPT. The overall sensitivity of imaging was 63.9% in the MIBI group (n = 116), compared with 94.4% (P &amp;lt; 0.001) in the FCh group (n = 69). FCh provided clear unilateral localization in 86.9% of patients, avoiding unnecessary bilateral neck exploration; in contrast, based on MIBI results, unilateral localization would have been theoretically possible in only 61.6% of patients. Compared with the MIBI group, patients in the FCh group had significantly lower preoperative calcium levels (2.71 versus 2.79\u2005mmol\/l; P = 0.012), lower preoperative parathyroid hormone levels (177 versus 250\u2005pg\/ml; P = 0.032), and smaller (17 versus 21\u2005mm; P &amp;lt;0.001) and lighter (1.47 versus 2.58\u2005g, P = 0.005) parathyroid glands removed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>FCh enables successful focused parathyroidectomy in PHPT patients with negative or inconclusive MIBI results, reducing unnecessary bilateral neck exploration in 33% of patients; it may also allow for a successful focused approach in patients with milder PHPT, characterized by lower preoperative calcium and PTH levels and smaller pathological parathyroid glands.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/bjsopen\/zraf069","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T11:28:45Z","timestamp":1753183725000},"source":"Crossref","is-referenced-by-count":5,"title":["Impact of 18F-choline PET-CT or PET-MRI on surgical strategy in patients with primary hyperparathyroidism"],"prefix":"10.1093","volume":"9","author":[{"given":"Jose Luis","family":"Carrillo Lizarazo","sequence":"first","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Cecchin","sequence":"additional","affiliation":[{"name":"Nuclear Medicine Unit, Department of Medicine, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1634-951X","authenticated-orcid":false,"given":"Valentina","family":"Camozzi","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology, Department of Medicine, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Crim\u00ec","sequence":"additional","affiliation":[{"name":"Radiology Unit, Department of Medicine, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Torresan","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6057-4642","authenticated-orcid":false,"given":"Maurizio","family":"Iacobone","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua , Padua ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,8,2]]},"reference":[{"key":"2025080204091732000_zraf069-B1","doi-asserted-by":"crossref","first-page":"390","DOI":"10.3390\/biomedicines9040390","article-title":"Preoperative localization for primary hyperparathyroidism: a clinical review","volume":"9","author":"Tay","year":"2021","journal-title":"Biomedicines"},{"key":"2025080204091732000_zraf069-B2","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1002\/hed.25111","article-title":"Preoperative imaging for parathyroid localization in patients with concurrent thyroid disease: a systematic review","volume":"40","author":"Frank","year":"2018","journal-title":"Head Neck"},{"key":"2025080204091732000_zraf069-B3","doi-asserted-by":"crossref","first-page":"42","DOI":"10.14310\/horm.2002.11167","article-title":"The value of scintigraphy and ultrasonography in the preoperative localization of parathyroid glands in patients with primary hyperparathyroidism and concomitant thyroid disease","volume":"5","author":"Alexandrides","year":"2006","journal-title":"Hormones (Athens)"},{"key":"2025080204091732000_zraf069-B4","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1111\/j.1365-2265.2006.02601.x","article-title":"Ultrasonography in detection of single and multiple abnormal parathyroid glands in primary hyperparathyroidism: comparison with radionuclide scintigraphy and surgery","volume":"65","author":"Bhansali","year":"2006","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2025080204091732000_zraf069-B5","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1245\/s10434-011-1870-5","article-title":"A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism","volume":"19","author":"Cheung","year":"2012","journal-title":"Ann Surg Oncol"},{"key":"2025080204091732000_zraf069-B6","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1245\/s10434-010-1493-2","article-title":"Primary hyperparathyroidism patients with positive preoperative sestamibi scan and negative ultrasound are more likely to have posteriorly located upper gland adenomas (PLUGs)","volume":"18","author":"Harari","year":"2011","journal-title":"Ann Surg Oncol"},{"key":"2025080204091732000_zraf069-B7","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.2967\/jnumed.107.040428","article-title":"Comparison of SPECT\/CT, SPECT, and planar imaging with single- and dual-phase 99mTc-sestamibi parathyroid scintigraphy","volume":"48","author":"Lavely","year":"2007","journal-title":"J Nucl Med"},{"key":"2025080204091732000_zraf069-B8","doi-asserted-by":"crossref","first-page":"2012","DOI":"10.2967\/jnumed.108.054858","article-title":"Preoperative 123I\/99mTc-sestamibi subtraction SPECT and SPECT\/CT in primary hyperparathyroidism","volume":"49","author":"Neumann","year":"2008","journal-title":"J Nucl Med"},{"key":"2025080204091732000_zraf069-B9","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/RLU.0b013e31823362e5","article-title":"Dual-phase 99mTc sestamibi scintigraphy with neck and thorax SPECT\/CT in primary hyperparathyroidism: a single-institution experience","volume":"37","author":"Ciappuccini","year":"2012","journal-title":"Clin Nucl Med"},{"key":"2025080204091732000_zraf069-B10","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1016\/j.crad.2009.12.005","article-title":"Clinical utility of ultrasound and 99mTc sestamibi SPECT\/CT for preoperative localization of parathyroid adenoma in patients with primary hyperparathyroidism","volume":"65","author":"Patel","year":"2010","journal-title":"Clin Radiol"},{"key":"2025080204091732000_zraf069-B11","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1007\/s12149-007-0086-z","article-title":"Preoperative evaluation of hyperparathyroidism: the role of dual-phase parathyroid scintigraphy and ultrasound imaging","volume":"22","author":"Sukan","year":"2008","journal-title":"Ann Nucl Med"},{"key":"2025080204091732000_zraf069-B12","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1007\/s12149-020-01507-1","article-title":"18F-Choline PET\/CT and PET\/MRI in primary and recurrent hyperparathyroidism: a systematic review of the literature","volume":"34","author":"Evangelista","year":"2020","journal-title":"Ann Nucl Med"},{"key":"2025080204091732000_zraf069-B13","doi-asserted-by":"crossref","first-page":"e18681","DOI":"10.1097\/MD.0000000000018681","article-title":"Added value of 18F-fluorocholine positron emission tomography-computed tomography in presurgical localization of hyperfunctioning parathyroid glands after dual tracer subtraction scintigraphy failure: a retrospective study of 47 patients","volume":"99","author":"Morland","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"2025080204091732000_zraf069-B14","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1007\/s00259-014-2837-0","article-title":"18F-Fluorocholine PET\/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study","volume":"41","author":"Lezaic","year":"2014","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2025080204091732000_zraf069-B15","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1001\/jamaoto.2024.4453","article-title":"Intraoperative parathyroid hormone monitoring criteria in primary hyperparathyroidism: a network meta-analysis of diagnostic test accuracy","volume":"151","author":"Staibano","year":"2025","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2025080204091732000_zraf069-B16","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1002\/bjs.4814","article-title":"Conventional bilateral cervical exploration versus open minimally invasive parathyroidectomy under local anaesthesia for primary hyperparathyroidism","volume":"92","author":"Bergenfelz","year":"2005","journal-title":"Br J Surg"},{"key":"2025080204091732000_zraf069-B17","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1001\/jamaoto.2024.1421","article-title":"F18-choline PET\/CT or MIBI SPECT\/CT in the surgical management of primary hyperparathyroidism: a diagnostic randomized clinical trial","volume":"150","author":"Quak","year":"2024","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"key":"2025080204091732000_zraf069-B18","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1007\/s00423-009-0529-1","article-title":"Surgical strategy for sporadic primary hyperparathyroidism an evidence-based approach to surgical strategy, patient selection, surgical access, and reoperations","volume":"394","author":"Mihai","year":"2009","journal-title":"Langenbecks Arch Surg"},{"key":"2025080204091732000_zraf069-B19","doi-asserted-by":"crossref","first-page":"535","DOI":"10.4103\/ijem.IJEM_707_17","article-title":"Fluorocholine PET imaging of parathyroid disease","volume":"22","author":"Prabhu","year":"2018","journal-title":"Indian J Endocrinol Metab"},{"key":"2025080204091732000_zraf069-B20","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.2967\/jnumed.120.257303","article-title":"Assessment and comparison of 18F-fluorocholine PET and 99mTc-sestamibi scans in identifying parathyroid adenomas: a metaanalysis","volume":"62","author":"Whitman","year":"2021","journal-title":"J Nucl Med"},{"key":"2025080204091732000_zraf069-B21","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1007\/s00268-019-04910-6","article-title":"18F-Fluorocholine PET\/CT and parathyroid 4D computed tomography for primary hyperparathyroidism: the challenge of reoperative patients","volume":"43","author":"Amadou","year":"2019","journal-title":"World J Surg"},{"key":"2025080204091732000_zraf069-B22","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.ejso.2016.09.016","article-title":"Focused parathyroidectomy without intraoperative parathormone testing is safe after pre-operative localization with 18F-fluorocholine PET\/CT","volume":"43","author":"Hocevar","year":"2017","journal-title":"Eur J Surg Oncol"},{"key":"2025080204091732000_zraf069-B23","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1097\/MNM.0000000000000595","article-title":"Fluorine-18 fluorocholine PET-CT localizes hyperparathyroidism in patients with inconclusive conventional imaging: a multicenter study from the Netherlands","volume":"37","author":"Kluijfhout","year":"2016","journal-title":"Nucl Med Commun"},{"key":"2025080204091732000_zraf069-B24","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1007\/s00259-017-3911-1","article-title":"F18-choline PET\/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT\/CT are negative or inconclusive: the APACH1 study","volume":"45","author":"Quak","year":"2018","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2025080204091732000_zraf069-B25","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1007\/s00259-023-06488-7","article-title":"Head-to-head comparison of [11C]methionine PET, [11C]choline PET, and 4-dimensional CT as second-line scans for detection of parathyroid adenomas in primary hyperparathyroidism","volume":"51","author":"Noltes","year":"2024","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2025080204091732000_zraf069-B26","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.1007\/s00259-024-06707-9","article-title":"How nuclear imaging changed parathyroid surgical strategies through time","volume":"51","author":"Schouw","year":"2024","journal-title":"Eur J Nucl Med Mol Imaging"},{"key":"2025080204091732000_zraf069-B27","doi-asserted-by":"crossref","first-page":"577","DOI":"10.2967\/jnumed.119.229914","article-title":"18F-Fluorocholine PET\/CT in primary hyperparathyroidism: superior diagnostic performance to conventional scintigraphic imaging for localization of hyperfunctioning parathyroid glands","volume":"61","author":"Cuderman","year":"2020","journal-title":"J Nucl Med"},{"key":"2025080204091732000_zraf069-B28","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1007\/s00259-017-3920-0","article-title":"18F-Fluorocholine PET\/CT as a second line nuclear imaging technique before surgery for primary hyperparathyroidism","volume":"45","author":"Imperiale","year":"2018","journal-title":"Eur J Nucl Med Mol Imaging"},{"issue":"(11S","key":"2025080204091732000_zraf069-B29","doi-asserted-by":"crossref","first-page":"S406","DOI":"10.1016\/j.jacr.2021.08.013","article-title":"ACR Appropriateness Criteria\u00ae parathyroid adenoma","volume":"18","author":"Zander","year":"2021","journal-title":"J Am Coll Radiol"},{"key":"2025080204091732000_zraf069-B30","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1109\/TRPMS.2020.3033561","article-title":"Improvement of spatial resolution with iterative PET reconstruction using UltraFast TOF","volume":"5","author":"Toussaint","year":"2021","journal-title":"IEEE Trans Radiat Plasma Med Sci"},{"key":"2025080204091732000_zraf069-B31","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1007\/s00423-019-01823-9","article-title":"Parathyroid surgery: an evidence-based volume-outcomes analysis: European Society of Endocrine Surgeons (ESES) positional statement","volume":"404","author":"Iacobone","year":"2019","journal-title":"Langenbecks Arch Surg"},{"key":"2025080204091732000_zraf069-B32","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1148\/radiol.2019182122","article-title":"Diagnostic performance of 4D CT and sestamibi SPECT\/CT in localizing parathyroid adenomas in primary hyperparathyroidism","volume":"291","author":"Yeh","year":"2019","journal-title":"Radiology"},{"key":"2025080204091732000_zraf069-B33","doi-asserted-by":"crossref","first-page":"25","DOI":"10.3390\/diagnostics14010025","article-title":"Diagnostic performance of magnetic resonance imaging for parathyroid localization of primary hyperparathyroidism: a systematic review","volume":"14","author":"Scheepers","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"2025080204091732000_zraf069-B34","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1007\/s00423-023-02893-6","article-title":"18F-fluorocholine PET\/MRI versus ultrasound and sestamibi for the localization of parathyroid adenomas","volume":"408","author":"Noltes","year":"2023","journal-title":"Langenbecks Arch Surg"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/9\/4\/zraf069\/63923613\/zraf069.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/9\/4\/zraf069\/63923613\/zraf069.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T08:09:24Z","timestamp":1754122164000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zraf069\/8221340"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":34,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zraf069","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,1]]},"article-number":"zraf069"}}