Diagnostic Performance of 18F-fluorocholine PET/CT Compared to 99mTc-Sestamibi Scintigraphy in Diagnosis of Parathyroid Adenoma

Background: In most hyperparathyroidism cases, the disease is related to parathyroid adenoma (PTA). Owing to the inconsistencies of currently approved imaging methods, novel methods for detecting PTA are being evaluated. This study aimed to compare 18F-fluorocholine PET/CT with 99mTc-sestamibi SPECT/CT in identifying PTA in Saudi patients.Methods and Results: The study included 40 adult patients with PTA diagnosed by histopathological findings. 99mTc-sestamibi SPECT/CT and 18F-fluorocholine PET/CT examinations were performed for each patient, and parathyroid hormone (PTH) levels and histologic findings were recorded. The diagnostic ability of 18F-fluorocholine PET/CT (AUC=0.720; P=0.029) was superior to 99mTc-sestamibi SPECT/CT (AUC=0.623; P=0.214) in identifying PTA. The sensitivity and accuracy of 18F-fluorocholine PET/CT (81.5% and 75%, respectively) were significantly (P<0.05) higher than that of 99mTc-sestamibi SPECT/CT (63% and 62.5%, respectively). 18F-fluorocholine PET/CT findings were correlated significantly (P=0.023) with PTH results. Conclusion: 18F-fluorocholine PET/CT is a diagnostic imaging method superior to conventional modality 99mTc-sestamibi SPECT/CT in the detection of PTA and, thus, allows for accurate preoperative localization.