{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:00:48Z","timestamp":1790744448384,"version":"4.1.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T00:00:00Z","timestamp":1762992000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>\n                      Accurate localization of hyperactive parathyroid glands is essential in managing primary hyperparathyroidism. Despite advances in imaging, discordant findings still complicate surgical planning. Tc-99m-sestaMIBI SPECT\/CT (MIBI SPECT\/CT) and\n                      <jats:sup>18<\/jats:sup>\n                      F-Choline PET\/CT (FCH PET\/CT) are commonly used, particularly when localization is discordant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study compared the findings of FCH PET\/CT and MIBI SPECT\/CT with intraoperative outcomes in patients who underwent parathyroidectomy for primary hyperparathyroidism. In discordant cases, the relative diagnostic performance and postoperative outcomes of the two modalities were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 133 patients who underwent parathyroidectomy between January 2020 and December 2024 and had both MIBI SPECT\/CT and FCH PET\/CT. Patients were classified according to concordance between imaging and surgical localization: Group 1 (both modalities concordant), Group 2 (MIBI concordant only), Group 3 (FCH concordant only), and Group 4 (both discordant). Diagnostic performance (sensitivity and PPV) and biochemical cure\u2014defined as normalization of parathyroid hormone (PTH) and calcium at 6 and 12 months\u2014were compared between Groups 2 and 3.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 133 patients, 82 (61.7%) were in Group 1, 5 (3.8%) in Group 2, 37 (27.8%) in Group 3, and 9 (6.8%) in Group 4. Sensitivity and PPV were 74.4% and 86.1% for MIBI, and 97.5% and 91.5% for FCH PET\/CT, respectively. The biochemical cure rate was 80.0% vs 94.6% at 6 months and 50.0% vs 87.5% at 12 months for Groups 2 and 3, with calcium levels remaining within the normal range. Preoperative PTH levels and chief-cell proportions were higher in Group 3 (91.9%) than in Group 1 (82.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>FCH PET\/CT demonstrated better diagnostic performance and higher cure rates than MIBI SPECT\/CT in discordant cases. Although differences were not statistically significant, they may be influenced by preoperative parathyroid activity and histologic composition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>FCH PET\/CT showed a trend toward improved diagnostic performance and postoperative cure compared with MIBI SPECT\/CT in discordant cases. While not superior in all situations, it can complement MIBI SPECT\/CT and enhance surgical decision-making in complex clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2025.1677278","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T12:38:17Z","timestamp":1763037497000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparison of 18F-Choline PET\/CT and 99mTc-Sestamibi SPECT\/CT in the Localization of Hyperactive Parathyroid Glands in Primary Hyperparathyroidism: Diagnostic Performance in Discordant Cases"],"prefix":"10.3389","volume":"16","author":[{"given":"Sungkeun","family":"Kang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hojin","family":"Cho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunjin","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Kyong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-wook","family":"Kang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jong Ju","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kee-Hyun","family":"Nam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Woungyoun","family":"Chung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196908142810708","article-title":"Hyperparathyroidism","volume":"281","author":"Goldsmith","year":"1969","journal-title":"New Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1106636","article-title":"Primary hyperparathyroidism","volume":"365","author":"Marcocci","year":"2011","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2022.08.024","article-title":"C11 choline PET\/CT succeeds when conventional imaging for primary hyperparathyroidism fails","volume":"173","author":"Saha","year":"2023","journal-title":"Surgery"},{"key":"B4","doi-asserted-by":"publisher","first-page":"96","DOI":"10.23736\/S1824-4785.23.03513-6","article-title":"18F-fluorocholine PET\/CT detects parathyroid gland hyperplasia as well as adenoma: 401 PET\/CTs in one center","volume":"67","author":"Talbot","year":"2023","journal-title":"Q J Nucl Med Mol Imaging"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-15-0565","article-title":"Imaging of the parathyroid glands in primary hyperparathyroidism","volume":"174","author":"Minisola","year":"2016","journal-title":"Eur J Endocrinol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02487-y","article-title":"Will 18F-fluorocholine PET\/CT replace other methods of preoperative parathyroid imaging","volume":"71","author":"Giovanella","year":"2021","journal-title":"Endocrine"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1007\/s13304-025-02090-8","article-title":"How has the diagnostic approach to parathyroid localization techniques evolved in the past decade? Insights from a single-center experience","volume":"77","author":"Cacciatore","year":"2025","journal-title":"Upd Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.23736\/S1824-4785.23.03512-4","article-title":"Detection, resection and cure: a systematic review and meta-analysis of 18F-choline PET in primary hyperparathyroidism","volume":"67","author":"Quak","year":"2023","journal-title":"Q J Nucl Med Mol Imaging"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad073","article-title":"FCH-PET\/CT in primary hyperparathyroidism with discordant\/negative MIBI scintigraphy and ultrasonography","volume":"108","author":"Koumakis","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2016.08.054","article-title":"Differences in single gland and multigland disease are seen in low biochemical profile primary hyperparathyroidism","volume":"161","author":"Lim","year":"2017","journal-title":"Surgery"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-012-1438-y","article-title":"Surgical management of normocalcemic primary hyperparathyroidism","volume":"36","author":"Wade","year":"2012","journal-title":"World J Surg"},{"key":"B12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12902-020-00667-5","article-title":"Upfront F18-choline PET\/CT versus Tc99m-sestaMIBI SPECT\/CT guided surgery in primary hyperparathyroidism: the randomized phase III diagnostic trial APACH2","volume":"21","author":"Quak","year":"2021","journal-title":"BMC Endocr Disord"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1007\/s12672-018-0347-4","article-title":"Diagnostic performance of F-18 fluorocholine PET\/CT for parathyroid localization in hyperparathyroidism: a systematic review and meta-analysis","volume":"9","author":"Kim","year":"2018","journal-title":"Horm 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