{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:32:17Z","timestamp":1792715537587,"version":"4.5.0"},"reference-count":26,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100017244","name":"Military Institute of Medicine-National Research Institute","doi-asserted-by":"publisher","award":["544\/2018"],"award-info":[{"award-number":["544\/2018"]}],"id":[{"id":"10.13039\/501100017244","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Introduction: Tertiary hyperparathyroidism (tHP) may develop in patients treated with hemodialysis or peritoneal dialysis. Parathyroidectomy may result in a significant reduction in the severity of symptoms. For the effective surgical treatment of hyperparathyroidism, proper localization of the parathyroid glands prior to surgery is essential. The sensitivity of scintigraphy in the diagnosis of tHP is lower than in the diagnosis of primary hyperparathyroidism. In recent years, positron emission tomography (PET\/CT) has been gaining importance, usually as a complementary technique. Aim: The aim of this study was to determine the usefulness of PET\/CT with [11C]MET in the preoperative localization diagnosis of patients with tertiary hyperparathyroidism caused by chronic kidney disease, in whom first-line diagnostic methods did not allow the localization of pathologically parathyroid glands. Material and methods: The study was conducted in a group of 19 adult patients with severe tHP who were resistant or intolerant to non-invasive treatment, with negative results of scintigraphy and ultrasonography of the neck. The study protocol included measurement of the concentration of calcium, phosphorus, and PTH in the blood serum and performing PET\/CT with [11C]MET. Results: A positive result of PET\/CT was obtained in 89.5% of the patients (17\/19). Parathyroidectomy was performed in 52.9% of the patients (9\/17) with positive results of PET\/CT with [11C]MET, which were fully consistent with the results of the histopathological examinations of the removed parathyroid glands. On this basis, the sensitivity of PET\/CT with [11C]MET in the preoperative localization diagnosis of patients with tHP was found to be 100%. Multiple lesions were visualized in 57.9% of the patients (11\/19). Ectopic lesions were visualized in 21.1% of the patients (4\/19). Conclusions: PET\/CT with [11C]MET is a sensitive technique for the second-line preoperative imaging of parathyroid glands in patients with tertiary hyperparathyroidism in whom first-line examinations, such as ultrasound and scintigraphy, has failed.<\/jats:p>","DOI":"10.3390\/nu15010188","type":"journal-article","created":{"date-parts":[[2023,1,2]],"date-time":"2023-01-02T02:44:03Z","timestamp":1672627443000},"page":"188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Usefulness of PET\/CT with Carbon-11-Labeled Methionine in the Diagnosis of Tertiary Hyperparathyroidism"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1943-264X","authenticated-orcid":false,"given":"Maciej","family":"Ko\u0142odziej","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marek","family":"Saracyn","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3248-4615","authenticated-orcid":false,"given":"Arkadiusz","family":"Lubas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miros\u0142aw","family":"Dziuk","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7103-2577","authenticated-orcid":false,"given":"Adam Daniel","family":"Durma","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerzy","family":"Smoszna","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Zelichowski","sequence":"additional","affiliation":[{"name":"DaVita Dialysis Unit, Wolski Hospital, 01-211 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanis\u0142aw","family":"Niemczyk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Nephrology and Dialysis, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grzegorz","family":"Kami\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Isotope Therapy, Military Institute of Medicine-National Research Institute, 04-141 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,30]]},"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":"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_3","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_4","doi-asserted-by":"crossref","first-page":"2801","DOI":"10.1007\/s00259-021-05334-y","article-title":"The EANM practice guidelines for parathyroid imaging","volume":"48","author":"Giovanella","year":"2021","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kidney Disease: Improving Global Outcomes (KDIGO) CKDMBD Update Work Group (2017). KDIGO clinical practice guideline for the diagnosis evaluation, prevention and treatment of chronic kidney disease mineral and bone disorder (CKD-MBD). Kidney Int. Suppl., 7, S1\u2013S130.","DOI":"10.1016\/j.kisu.2017.04.001"},{"key":"ref_6","unstructured":"GBD Chronic Kidney Disease Collaboration (2020). Global, regional, and national burden of chronic kidney disease, 1990\u20132017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet, 395, 709\u2013733."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1007\/s12149-012-0643-y","article-title":"Diagnostic performance of planar scintigraphy using 99mTc-MIBI in patients with secondary hyperparathyroidism: A meta-analysis","volume":"26","author":"Caldarella","year":"2012","journal-title":"Ann. Nucl. Med."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Zhang, R., Zhang, Z., Huang, P., Li, Z., Hu, R., Zhang, J., Qiu, W., and Hu, P. (2020). Diagnostic performance of ultrasonography, dual-phase 99mTc-MIBI scintigraphy, early and delayed 99mTc-MIBI SPECT\/CT in preoperative parathyroid gland localization in secondary hyperparathyroidism. BMC Med. Imaging, 20.","DOI":"10.1186\/s12880-020-00490-3"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Jiang, S.Q., Yang, T., Zou, Q., Xu, L., Ye, T., Kang, Y.Q., Li, W.R., Jiao, J., and Zhang, Y. (2020). The role of 99mTc-MIBI SPECT\/CT in patients with secondary hyperparathyroidism: Comparison with 99mTc-MIBI planar scintigraphy and ultrasonography. BMC Med. Imaging, 20.","DOI":"10.1186\/s12880-020-00517-9"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1097\/RLU.0b013e318251e408","article-title":"Parathyroid scintigraphy: When, how, and why? A concise systematic review","volume":"37","author":"Taieb","year":"2012","journal-title":"Clin. Nucl. Med."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Tay, D., Das, J., and Yeh, R. (2021). Preoperative Localization for Primary Hyperparathyroidism: A Clinical Review. Biomedicines, 9.","DOI":"10.3390\/biomedicines9040390"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2214\/AJR.17.18312","article-title":"11C-Choline PET\/CT for Detection and Localization of Parathyroid Adenomas","volume":"210","author":"Parvinian","year":"2018","journal-title":"Am. J. Roentgenol."},{"key":"ref_13","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 para-thyroid 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_14","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s12020-013-9891-4","article-title":"The use of positron emission tomography with 11C-methionine in patients with primary hyperparathyroidism","volume":"43","author":"Cetani","year":"2013","journal-title":"Endocrine"},{"key":"ref_15","first-page":"1405","article-title":"Pre-operative localisation of hyperfunctional parathyroid tissue with 11C-methionine PET","volume":"31","author":"Otto","year":"2004","journal-title":"Eur. J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1007\/s00423-016-1425-0","article-title":"Use of PET tracers for parathyroid localization: A systematic review and meta-analysis","volume":"401","author":"Kluijfhout","year":"2016","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s00423-017-1549-x","article-title":"Localization of parathyroid adenomas using 11C-methionine pet after prior inconclusive imaging","volume":"402","author":"Noltes","year":"2017","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1097\/MNM.0000000000000216","article-title":"A comparison between 11C-methionine PET\/CT and MIBI SPECT\/CT for localization of parathyroid adenomas\/hyperplasia","volume":"36","author":"Hayakawa","year":"2015","journal-title":"Nucl. Med. Commun."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s00259-005-0008-z","article-title":"11C-methionine PET\/CT in 99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis","volume":"33","author":"Rubello","year":"2006","journal-title":"Eur. J. Nucl. Med. Mol. Imaging"},{"key":"ref_20","first-page":"102","article-title":"11C-methionine PET\/CT in the evaluation of 99mTc-sestamibi negative hyperparathyroidism in patients with chronic renal failure","volume":"58","author":"Quagliata","year":"2017","journal-title":"J. Nucl. Med."},{"key":"ref_21","first-page":"1766","article-title":"PET and parathyroid L-[carbon-11]methionine accumulation in hyperparathy-roidism","volume":"37","author":"Sundin","year":"1996","journal-title":"J. Nucl. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"355","DOI":"10.4103\/ijem.IJEM_445_16","article-title":"Five-year retrospective study on primary hyperparathyroidism in South India: Emerging roles of minimally invasive parathyroidectomy and preoperative localization with methionine positron emission tomography-computed tomography scan","volume":"22","author":"Mathew","year":"2018","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4199","DOI":"10.1210\/jc.2014-1267","article-title":"11C-methionine PET\/CT imaging of 99mTc-MIBI-SPECT\/CT-negative patients with primary hyperparathyroidism and previous neck surgery","volume":"99","author":"Mayerhoefer","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1530\/EJE-21-0038","article-title":"Comparison of the diagnostic accuracy of 18F-Fluorocholine PET and 11C-Methionine PET for parathyroid localization in primary hyperparathyroidism: A systematic review and meta-analysis","volume":"185","author":"Bioletto","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1001\/jamaoto.2021.0915","article-title":"Direct Comparison of Preoperative Imaging Modalities for Localization of Primary Hyperparathyroidism: A Systematic Review and Network Meta-analysis","volume":"147","author":"Lee","year":"2021","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13550-019-0583-9","article-title":"The role of 18F-FCH PET\/CT in patients with uremic hyperparathyroidism compared with 99mTc-sestaMIBI SPECT\/CT and ultrasonography","volume":"9","author":"Xue","year":"2019","journal-title":"EJNMMI Res."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/1\/188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:48:32Z","timestamp":1760147312000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/15\/1\/188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,30]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["nu15010188"],"URL":"https:\/\/doi.org\/10.3390\/nu15010188","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,30]]}}}