From Second-Line to First-Line: The Emerging Role of 11C - Choline PET/CT in Parathyroid Surgery
Autores
Ana Luís Martins, Carlos E. Costa Almeida, Joana Oliveira, Paulo Menezes, Pedro Mesquita, Patrícia Gilde, Paula Messias
Resumo Introdução
Accurate preoperative localization is essential for minimally invasive parathyroidectomy. Cervical ultrasound (US) and 99mTc-sestamibi (MIBI) remain the standard first-line imaging modalities, although their performance is variable. Choline PET/CT, traditionally reserved for discordant or negative US/MIBI studies, has shown high diagnostic accuracy and may be suitable as a first-line option.
Resumo Métodos
We performed a retrospective single-center analysis of 47 consecutive patients undergoing parathyroidectomy for primary hyperparathyroidism (January 2024?October 2025). All patients underwent US and MIBI. 11C - Choline PET/CT was obtained when first-line imaging was inadequate. Diagnostic accuracy was correlated with surgical findings and histopathology.
Resumo Resultados
Parathyroid pathology was confirmed in all patients. US localized adenomas in 29%, and MIBI in 70%. Due to inadequate standard imaging, 25 patients (53%) underwent 11C - choline PET/CT, which demonstrated 100% positivity and 100% sensitivity on a patient-based analysis. In comparison, sensitivity was 76% for MIBI and 32% for US.
Resumo Discussão
11C - Choline PET/CT showed superior sensitivity and reliable localization in all discordant cases, directly facilitating minimally invasive parathyroidectomy. These findings support the potential adoption of choline PET/CT as a first-line imaging modality in the preoperative workup of primary hyperparathyroidism.