{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T19:46:56Z","timestamp":1765828016377,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T00:00:00Z","timestamp":1618272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The diagnostic performance of [18F]fluoro-ethylcholine-PET-CT&amp;4D-CT (FEC-PET&amp;4D-CT) to identify parathyroid adenomas (PA) was analyzed when ultrasound (US) or MIBI-Scan (MS) failed to localize. Postsurgical one year follow-up data are presented. Methods: Patients in whom US and MS delivered either incongruent or entirely negative findings were subjected to FEC-PET&amp;4D-CT and cases from July 2017 to June 2020 were analyzed, retrospectively. Cervical exploration with intraoperative PTH-monitoring (IO-PTH) was performed. Imaging results were correlated to intraoperative findings, and short term and one year postoperative follow-up data. Results: From July 2017 to June 2020 in 171 FEC-PET&amp;4D-CTs 159 (92.9%) PAs were suggested. 147 patients already had surgery, FEC-PET&amp;4D-CT accurately localized in 141; false neg. 4, false pos. 2, global sensitivity 0.97; accuracy 0.96, PPV 0.99. All of the 117 patients that already have completed their 12-month postoperative follow up had normal biochemical parameter, i.e., no signs of persisting disease. However, two cases may have a potential for recurrent disease, for a cure rate of at least 98.3%. Conclusion: FEC-PET&amp;4D-CT shows unprecedented results regarding the accuracy localizing PAs. The one-year-follow-up data demonstrate a high cure rate. We, therefore, suggest FEC-PET-CT as the relevant diagnostic tool for the localization of PAs when US fails to localize PA, especially after previous surgery to the neck.<\/jats:p>","DOI":"10.3390\/jcm10081648","type":"journal-article","created":{"date-parts":[[2021,4,13]],"date-time":"2021-04-13T05:31:37Z","timestamp":1618291897000},"page":"1648","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["[18F]fluoro-ethylcholine-PET Plus 4D-CT (FEC-PET-CT): A Break-Through Tool to Localize the \u201cNegative\u201d Parathyroid Adenoma. One Year Follow Up Results Involving 170 Patients"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4650-3167","authenticated-orcid":false,"given":"Constantin","family":"Smaxwil","sequence":"first","affiliation":[{"name":"Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Aschoff","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine and PET-CT Centre, Institute of Diagnostic and Interventional Radiology, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3961-116X","authenticated-orcid":false,"given":"Gerald","family":"Reischl","sequence":"additional","affiliation":[{"name":"Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University of Tuebingen, 72076 Tuebingen, Germany"},{"name":"Cluster of Excellence iFIT (EXC 2180) Image Guided and Functionally Instructed Tumor Therapies, University of Tuebingen, 72076 Tuebingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirjam","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Wagner","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Altmeier","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oswald","family":"Ploner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Endocrinology, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7799-4099","authenticated-orcid":false,"given":"Andreas","family":"Zielke","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery, Endokrines Zentrum Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(09)60507-9","article-title":"Hyperparathyroidism","volume":"374","author":"Fraser","year":"2009","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1001\/2013.jamasurg.316","article-title":"Parathyroidectomy, elevated depression scores, and suicidal ideation in patients with primary hyperparathyroidism: Results of a prospective multicenter study","volume":"148","author":"Weber","year":"2013","journal-title":"JAMA Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1016\/j.suc.2004.01.002","article-title":"Minimal-access\/minimally invasive parathyroidectomy for primary hyperparathyroidism","volume":"84","author":"Palazzo","year":"2004","journal-title":"Surg. Clin. N. Am."},{"key":"ref_4","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":"ref_5","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 (18)F-Fluorocholine PET\/CT","volume":"43","author":"Hocevar","year":"2017","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_6","first-page":"187","article-title":"Development of (18F)-fluoroethylcholine for cancer imaging with PET: Synthesis, biochemistry, and prostate cancer imaging","volume":"43","author":"Hara","year":"2002","journal-title":"J. Nucl. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e1701","DOI":"10.1097\/MD.0000000000001701","article-title":"A Pilot Comparison of 18F-fluorocholine PET\/CT, Ultrasonography and 123I\/99mTc-sestaMIBI Dual-Phase Dual-Isotope Scintigraphy in the Preoperative Localization of Hyperfunctioning Parathyroid Glands in Primary or Secondary Hyperparathyroidism: Influence of Thyroid Anomalies","volume":"94","author":"Michaud","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1148\/radiol.13122661","article-title":"How to perform parathyroid 4D CT: Tips and traps for technique and interpretation","volume":"270","author":"Hoang","year":"2014","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jamasurg.2016.2310","article-title":"The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism","volume":"151","author":"Wilhelm","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_10","unstructured":"CAEK (2021, March 30). S2k-Leitlinie HPT: Chirurgisches Management des Prim\u00e4ren und Renalen Hyperparathyreoidismus. AWMF (Currently under Revision). Available online: https:\/\/www.awmf.org\/leitlinien\/detail\/ll\/174-006.html."},{"key":"ref_11","unstructured":"DGAV (2021, March 30). Thyroid Surgery Quality Assurance Registry of the German Association of Surgeons (DGAV); StuDoQ|Thyroid. Available online: http:\/\/www.dgav.de\/studoq.html."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s13304-017-0447-7","article-title":"Persistent and recurrent hyperparathyroidism","volume":"69","author":"Guerin","year":"2017","journal-title":"Updates Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1097\/00000658-197610000-00001","article-title":"Recurrent hyperparathyroidism","volume":"184","author":"Clark","year":"1976","journal-title":"Ann. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s00104-004-0994-6","article-title":"Reoperation for primary hyperparathyroidism","volume":"76","author":"Karakas","year":"2005","journal-title":"Chirurg"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1055\/s-0029-1212122","article-title":"Diagnostic strategies and surgical procedures in persistent or recurrent primary hyperparathyroidism","volume":"107","author":"Mundschenk","year":"1999","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1055\/a-0837-1013","article-title":"Risk Factors for Permanent Postoperative Hypoparathyreoidism","volume":"145","author":"Allemeyer","year":"2020","journal-title":"Zentralbl. Chir."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2304","DOI":"10.1007\/s00268-014-2571-6","article-title":"Factors predicting post-thyroidectomy hypoparathyroidism recovery","volume":"38","author":"Mubasher","year":"2014","journal-title":"World J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1001\/archsurg.137.9.1055","article-title":"Worldwide trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy","volume":"137","author":"Sackett","year":"2002","journal-title":"Arch. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1097\/01.sla.0000124448.49794.74","article-title":"Progress in the operative management of sporadic primary hyperparathyroidism over 34 years","volume":"239","author":"Irvin","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_20","unstructured":"(2021, March 30). [NG132], N.g. Hyperparathyroidism (Primary): Diagnosis, Assessment and Initial Management. Available online: https:\/\/www.nice.org.uk\/guidance\/ng132\/chapter\/Recommendations."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1055\/a-0950-9892","article-title":"Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia","volume":"128","author":"Dillenberger","year":"2020","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_22","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":"ref_23","doi-asserted-by":"crossref","first-page":"4202","DOI":"10.1245\/s10434-012-2512-2","article-title":"Preoperative localization strategies for primary hyperparathyroidism: An economic analysis","volume":"19","author":"Lubitz","year":"2012","journal-title":"Ann. Surg. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1007\/s12020-020-02487-y","article-title":"Will (18)F-fluorocholine PET\/CT replace other methods of preoperative parathyroid imaging?","volume":"71","author":"Giovanella","year":"2020","journal-title":"Endocrine"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"577","DOI":"10.2967\/jnumed.119.229914","article-title":"(18)F-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":"ref_26","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13550-019-0544-3","article-title":"Parathyroid imaging with (18)F-fluorocholine PET\/CT as a first-line imaging modality in primary hyperparathyroidism: A retrospective cohort study","volume":"9","author":"Broos","year":"2019","journal-title":"EJNMMI Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1088\/1361-6498\/aaa86f","article-title":"(18)F-choline PET\/CT for parathyroid scintigraphy: Significantly lower radiation exposure of patients in comparison to conventional nuclear medicine imaging approaches","volume":"38","author":"Rep","year":"2018","journal-title":"J. Radiol. Prot."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Quak, E., Lasne Cardon, A., Ciappuccini, R., Lasnon, C., Bastit, V., Le Henaff, V., Lireux, B., Foucras, G., Jaudet, C., and Berchi, C. (2021). Upfront F18-choline PET\/CT versus Tc99m-sestaMIBI SPECT\/CT guided surgery in primary hyperparathyroidism: The randomized phase III diagnostic trial APACH2. BMC Endocr. Disord., 21.","DOI":"10.1186\/s12902-020-00667-5"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/8\/1648\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:47:21Z","timestamp":1760161641000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/8\/1648"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,13]]},"references-count":28,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,4]]}},"alternative-id":["jcm10081648"],"URL":"https:\/\/doi.org\/10.3390\/jcm10081648","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,4,13]]}}}