Localization of Ectopic Hyperparathyroidism: Ultrasound Versus 99mTc-sestamibi, 4-Dimensional Computed Tomography, and 11C-choline Positron Emission Tomography/Computed Tomography

Abstract

Objective: To investigate the usefulness of ultrasound (US) for the localization of ectopic hyperparathyroidism and compare it with ^99mTc-sestamibi (^99mTc-MIBI), 4-dimensional computed tomography (4D-CT), and ¹¹C-choline positron emission tomography/ computed tomography (PET/CT).

Methods: Of the 527 patients with surgically confirmed primary hyperparathyroidism, 79 patients with ectopic hyperparathyroidism were enrolled. The diagnostic performance of US, ^99mTc-MIBI, US + MIBI, 4D-CT, and ¹¹C-choline PET/CT was calculated, and the factors affecting the sensitivity of US and ^99mTc-MIBI were analyzed.

Results: Eighty-three ectopic parathyroid lesions were found in 79 patients. The sensitivity was 75.9%, 81.7%, 95.1%, 83.3%, and 100% for US, 99mTc-MIBI, US + MIBI, 4D-CT, and ¹¹C-choline PET/CT, respectively. The difference in sensitivity among these different modalities did not achieve statistical significance (P > .05). The US sensitivity was significantly higher for ectopic lesions in the neck region than for those in the anterior mediastinum/chest wall (85.9% vs. 42.1%, P < .001). The ^99mTc-MIBI and 4D-CT sensitivity was not significantly different between these two groups (84.1% vs. 94.6%, P = .193 and 81.3% vs. 85.7%, P = 1). The ¹¹C-choline PET/CT sensitivity was 100% in both groups.

Conclusions: US is a valuable tool for the localization of ectopic hyperparathyroidism, especially for ectopic lesions in the neck region.

Keywords: (11)C-choline PET/CT; (99m)Tc-sestamibi; 4D-CT; ectopic; hyperparathyroidism; ultrasound.