{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T06:34:01Z","timestamp":1787898841485,"version":"build-2784847793"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2020,6,26]],"date-time":"2020-06-26T00:00:00Z","timestamp":1593129600000},"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>The present retrospective study evaluates the diagnostic value of integrated 18F-Fluorocholine positron emission tomography\/four-dimensional contrast-enhanced computed tomography (18F-FCH PET\/4D-CT) as second-line imaging in preoperative work-up of primary hyperparathyroidism (pHPT), and compares 18F-FCH PET with 4D-CT. Patients with pHPT and negative\/discordant first-line imaging addressed for integrated 18F-FCH PET\/4D-CT were retrospectively selected. Sensitivity and detection rate (DR%) of 18F-FCH PET\/CT, 4D-CT, and PET\/4D-CT were calculated according to the per patient and per lesion analyses, and afterwards compared. Histology associated with a decrease more than 50% of perioperative parathyroid hormone (PTH) blood level was used as a gold standard. Persistent high serum PTH and calcium levels during a 6-month follow-up was considered as presence of pHPT in both operated and non-operated patients. 50 patients (55 glands) were included. 44\/50 patients (88%) were surgically treated. On a per patient analysis, sensitivity was 93%, 80%, and 95%, and DR% was 82%, 68%, and 84%, respectively for PET\/CT, 4D-CT, and PET\/4D-CT. PET\/CT was more sensitive than 4D-CT (p = 0.046). PET\/4D-CT performed better than 4D-CT (p = 0.013) but was equivalent to PET\/CT alone. On a per gland analysis, sensitivity PET\/CT, 4D-CT, and PET\/4D-CT was 88%, 66%, and 92%, and DR% was 79%, 57%, and 83%, respectively. PET\/CT and PET\/4D-CT were more sensitive than 4D-CT alone (p = 0.01, p &lt; 0.001, respectively). However, PET\/CT and PET\/4D-CT performed similarly. In conclusion, 18F-FCH PET provides better identification of hyperfunctioning parathyroids than 4D-CT and the combination of both did not significantly improve diagnostic sensitivity. Further investigations involving larger populations are necessary to define the role of 18F-FCH PET\/4D-CT as a \u201cone-stop shop\u201d second-line imaging in preoperative work-up of pHPT, especially considering the additional patient radiation exposure due to multi-phase CT.<\/jats:p>","DOI":"10.3390\/jcm9062005","type":"journal-article","created":{"date-parts":[[2020,6,30]],"date-time":"2020-06-30T14:27:29Z","timestamp":1593527249000},"page":"2005","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["18F-Fluorocholine PET and Multiphase CT Integrated in Dual Modality PET\/4D-CT for Preoperative Evaluation of Primary Hyperparathyroidism"],"prefix":"10.3390","volume":"9","author":[{"given":"Valentin","family":"Pretet","sequence":"first","affiliation":[{"name":"Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianela","family":"Rotania","sequence":"additional","affiliation":[{"name":"Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France"},{"name":"Molecular and Nuclear Medicine, Instituto Oulton, X5000 JJS Cordoba, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Helali","sequence":"additional","affiliation":[{"name":"Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0250-3280","authenticated-orcid":false,"given":"Mihaela","family":"Ignat","sequence":"additional","affiliation":[{"name":"General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Vix","sequence":"additional","affiliation":[{"name":"General, Digestive, and Endocrine Surgery, IRCAD-IHU, University of Strasbourg, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio","family":"Imperiale","sequence":"additional","affiliation":[{"name":"Nuclear Medicine and Molecular Imaging, ICANS-University Hospitals of Strasbourg, 67033 Strasbourg, France"},{"name":"Faculty of Medicine, University of Strasbourg, 67033 Strasbourg, France"},{"name":"Molecular Imaging-DRHIM, IPHC, UMR 7178, CNRS\/Unistra, 67033 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.otohns.2004.10.005","article-title":"A systematic review of the diagnosis and treatment of primary hyperparathyroidism from 1995 to 2003","volume":"132","author":"Ruda","year":"2005","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.jocd.2012.11.009","article-title":"Epidemiology of primary hyperparathyroidism","volume":"16","author":"Clarke","year":"2013","journal-title":"J. Clin. Densitom."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/S0140-6736(17)31430-7","article-title":"Hyperparathyroidism","volume":"391","author":"Bilezikian","year":"2018","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1056\/NEJM200012213432508","article-title":"Hyperparathyroid and hypoparathyroid disorders","volume":"343","author":"Marx","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_5","first-page":"7","article-title":"Management of asymptomatic primary hyperparathyroidism: French Society of Endocrinology expert consensus","volume":"67","author":"Chanson","year":"2006","journal-title":"Ann. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3561","DOI":"10.1210\/jc.2014-1413","article-title":"Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the Fourth International Workshop","volume":"99","author":"Bilezikian","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1097\/SLA.0b013e318208fed9","article-title":"The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism","volume":"253","author":"Udelsman","year":"2011","journal-title":"Ann. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1530\/eje.1.02029","article-title":"Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: A decision analysis","volume":"153","author":"Sejean","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2398","DOI":"10.1002\/hed.25781","article-title":"American Head and Neck Society Endocrine Surgery Section update on parathyroid imaging for surgical candidates with primary hyperparathyroidism","volume":"41","author":"Zafereo","year":"2019","journal-title":"Head Neck."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.23736\/S0391-1977.17.02685-2","article-title":"Imaging in primary hyperparathyroidism: Focus on the evidence-based diagnostic performance of different methods","volume":"43","author":"Treglia","year":"2018","journal-title":"Minerva Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1210\/jc.2012-3168","article-title":"Clinical review: Parathyroid localization and implications for clinical management","volume":"98","author":"Kunstman","year":"2013","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.mric.2017.08.009","article-title":"Update in Parathyroid Imaging","volume":"26","author":"Kuzminski","year":"2018","journal-title":"Magn. Reson. Imaging Clin. N Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.ejrad.2017.01.004","article-title":"Diagnostic performance of computed tomography for parathyroid adenoma localization; A systematic review and meta-analysis","volume":"88","author":"Kluijfhout","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1007\/s00259-018-4123-z","article-title":"Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: A systematic review and meta-analysis","volume":"46","author":"Treglia","year":"2019","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1245\/s10434-014-3940-y","article-title":"The Use of Modified Four-Dimensional Computed Tomography in Patients with Primary Hyperparathyroidism: An Argument for the Abandonment of Routine Sestamibi Single-Positron Emission Computed Tomography (SPECT)","volume":"22","author":"Kukar","year":"2015","journal-title":"Ann. Surg. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1177\/0194599814562195","article-title":"Comparison of 4D CT, ultrasonography, and 99mTc sestamibi SPECT\/CT in localizing single-gland primary hyperparathyroidism","volume":"152","author":"Suh","year":"2015","journal-title":"Otolaryngol. Head. Neck Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"399","DOI":"10.4103\/ijem.IJEM_536_16","article-title":"Comparison of 18F-Fluorocholine Positron Emission Tomography\/Computed Tomography and Four-dimensional Computed Tomography in the Preoperative Localization of Parathyroid Adenomas-initial Results","volume":"21","author":"Taywade","year":"2017","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_18","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":"ref_19","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1007\/s00259-018-4147-4","article-title":"Additional value of integrated 18F-choline PET\/4D contrast-enhanced CT in the localization of hyperfunctioning parathyroid glands and correlation with molecular profile","volume":"46","author":"Piccardo","year":"2019","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1001\/jamasurg.2013.739","article-title":"Virtual neck exploration for parathyroid adenomas: A first step toward minimally invasive image-guided surgery","volume":"148","author":"Wall","year":"2013","journal-title":"JAMA Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1618","DOI":"10.1007\/s00268-013-2021-x","article-title":"Three-dimensional metabolic and radiologic gathered evaluation using VR-RENDER fusion: A novel tool to enhance accuracy in the localization of parathyroid adenomas","volume":"37","author":"Diana","year":"2013","journal-title":"World J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/RLU.0000000000000272","article-title":"Dual-isotope 99mTc-MIBI\/123I parathyroid scintigraphy in primary hyperparathyroidism: Comparison of subtraction SPECT\/CT and pinhole planar scan","volume":"39","author":"Hassler","year":"2014","journal-title":"Clin. Nucl. Med."},{"key":"ref_23","unstructured":"Lloyd, R.V., Osamura, R.Y., Kloppel, G., and Rosai, J. (2017). WHO Classification of Tumours of Endocrine Organs: WHO Classification of Tumours, International Agency for Research on Cancer. [4th ed.]."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S86","DOI":"10.21037\/gs.2019.11.10","article-title":"Surgical implications of recent modalities for parathyroid imaging","volume":"9","author":"Wojtczak","year":"2020","journal-title":"Gland. Surg."},{"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":"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":"29","author":"Yeh","year":"2019","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1605","DOI":"10.2967\/jnumed.118.225599","article-title":"Dual-Time-Point 18F-Fluorocholine PET\/CT in Parathyroid Imaging","volume":"60","author":"Broos","year":"2019","journal-title":"J. Nucl. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1007\/s11307-018-1179-x","article-title":"[18F]Fluorocholine Uptake of Parathyroid Adenoma Is Correlated with Parathyroid Hormone Level","volume":"20","author":"Alharbi","year":"2018","journal-title":"Mol. Imaging. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1097\/MNM.0000000000000899","article-title":"The efficacy of fluorine-18-choline PET\/CT in comparison with 99mTc-MIBI SPECT\/CT in the localization of a hyperfunctioning parathyroid gland in primary hyperparathyroidism","volume":"39","author":"Araz","year":"2018","journal-title":"Nucl. Med. Commun."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/j.surg.2016.03.002","article-title":"High-resolution magic angle spinning (1)H nuclear magnetic resonance spectroscopy metabolomics of hyperfunctioning parathyroid glands","volume":"160","author":"Battini","year":"2016","journal-title":"Surgery"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1001\/jamasurg.2013.57","article-title":"Comparison of radiation exposure and cost between dynamic computed tomography and sestamibi scintigraphy for preoperative localization of parathyroid lesions","volume":"148","author":"Madorin","year":"2013","journal-title":"JAMA Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1016\/j.surg.2014.08.002","article-title":"Multiphase computed tomography for localization of parathyroid disease in patients with primary hyperparathyroidism: How many phases do we really need?","volume":"156","author":"Noureldine","year":"2014","journal-title":"Surgery"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.ejrad.2019.01.022","article-title":"The diagnostic value of 4D MRI at 3T for the localization of parathyroid adenomas","volume":"112","author":"Ozturk","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"522","DOI":"10.3174\/ajnr.A6482","article-title":"4D-Dynamic Contrast-Enhanced MRI for Preoperative Localization in Patients with Primary Hyperparathyroidism","volume":"41","author":"Becker","year":"2020","journal-title":"AJNR Am. J. Neuroradiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/6\/2005\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:43:12Z","timestamp":1760175792000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/6\/2005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,26]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6]]}},"alternative-id":["jcm9062005"],"URL":"https:\/\/doi.org\/10.3390\/jcm9062005","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,26]]}}}