Head-to-head comparison among 18F-choline PET/CT, 4D contrast-enhanced CT, and 18F-choline PET/4D contrast-enhanced CT in the detection of hyperfunctioning parathyroid glands: a systematic review and meta-analysis

Arnoldo Piccardo; Gianluca Bottoni; Luis Alejandro Boccalatte; Chiara Camponovo; Martina Musumeci; Lorenzo Bacigalupo; Carlos Collaud; Martina Ugolini; Francesco Fiz; Pierpaolo Trimboli

doi:10.1007/s12020-021-02798-8

Head-to-head comparison among ¹⁸F-choline PET/CT, 4D contrast-enhanced CT, and ¹⁸F-choline PET/4D contrast-enhanced CT in the detection of hyperfunctioning parathyroid glands: a systematic review and meta-analysis

Endocrine. 2021 Nov;74(2):404-412. doi: 10.1007/s12020-021-02798-8. Epub 2021 Jun 25.

Authors

Affiliations

¹ Nuclear Medicine Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy.
² Department of Head and Neck Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
³ Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
⁴ Department of Endocrinology, Metabolism and Nuclear Medicine/PET-CT, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
⁵ Radiology Department, Ente Ospedaliero "Ospedali Galliera", Genoa, Italy.
⁶ Nuclear Medicine Department, Humanitas Research Hospital-IRCCS, Rozzano, Milan, Italy. francesco.fiz.nm@gmail.com.
⁷ Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.

PMID: 34173158
DOI: 10.1007/s12020-021-02798-8

Abstract

Introduction: In primary hyperparathyroidism (PHPT), the localization of hyperfunctioning parathyroid gland (HPTG) allows tailored surgery. Although Four-Dimensional Contrast-enhanced Computed Tomography (4DCeCT) and ¹⁸F-choline Positron Emission Tomography/Computed Tomography (PET/CT) are reported to be promising second-line imaging procedures, no meta-analysis of their comparison exists.

Design: we conducted a systematic review and meta-analysis to find original papers reporting the head-to-head comparison of 4DCeCT, ¹⁸F-choline PET/CT and integrated ¹⁸F-choline-PET/4DCeCT.

Methods: this systematic review was conducted according to PRISMA. PubMed, CENTRAL, Scopus, and Web of Science were searched until January 2021. Studies comparing the ability of 4DCeCT, ¹⁸F-choline PET/CT and ¹⁸F-choline PET/4DCeCT to identify HPTG in patients with PHPT were selected. A per patient-based analysis of the three procedures was conducted in all patients (detection rate, DR) and in those with histologically confirmed HPTG (sensitivity).

Results: Of the 78 records identified, five articles (153 PHPT patients) published between January the 1st, 2018 and January the 31st, 2021 were included. The pooled DR of ¹⁸F-choline PET/CT, 4DCeCT and ¹⁸F-choline PET/4DCeCT was 0.86, 0.69, and 0.86, respectively, while their pooled sensitivity was 0.89, 0.77 and 0.93, respectively. The analysis of pooled discrepancy showed that the sensitivity of ¹⁸F-choline PET/CT and ¹⁸F-choline PET/4DCeCT was higher than that of 4DCeCT by 0.11 and 0.13, respectively, the sensitivity of ¹⁸F-choline PET/4DCeCT being 0.06 higher than that of ¹⁸F-Choline PET/CT.

Conclusions: This meta-analysis suggests that the sensitivity of ¹⁸F-choline PET/CT and ¹⁸F-choline PET/4DCeCT is higher than that of 4DCeCT, while only a slight difference was observed between ¹⁸F-choline PET/CT and ¹⁸F-choline PET/4DCeCT.

Keywords: 4D-CeCT; Choline; Hyperparathyroidism; PET/CT; Parathyroid.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Bibliometrics
Choline
Humans
Hyperparathyroidism, Primary*
Parathyroid Glands / diagnostic imaging
Positron Emission Tomography Computed Tomography*

Substances

Choline