What question did this study set out to answer?

This trial aims to compare the effectiveness of 18F fluorocholine-PET-CT versus traditional imaging for localization in primary hyperparathyroidism.

May 20, 2026

18FFluorocholine-PET-CT reduces operation time and improves cure rate over ultrasonography and 99mTcTc-MIBI-scintigraphy for primary hyperparathyroidism, a randomized trial

Key Points

This trial aims to compare the effectiveness of 18F fluorocholine-PET-CT versus traditional imaging for localization in primary hyperparathyroidism.
Randomized non-blinded trial among adult patients with primary hyperparathyroidism.
Patients were allocated to either 18F fluorocholine-PET-CT or conventional imaging (ultrasonography and 99mTc-MIBI-scintigraphy).
4D-CT was performed if localization investigations failed.
The median operation time was 26 minutes in the PET group versus 34.5 minutes in the controls (p=0.042).
The biochemical cure rate was 100% in the PET group compared to 91% in controls (p=0.036).
No adverse events were reported.

Abstract

Abstract Background Ultrasonography and 99mTcTc-MIBI-scintigraphy have long been the standard imaging modalities in parathyroid surgery, but recent studies indicate that 18FFluorocholine-PET-CT is more accurate. This randomized study compared 18FFluorocholine-PET-CT to ultrasonography and 99mTcTc-MIBI-scintigraphy for first-line localization in patients with sporadic primary hyperparathyroidism. Methods In this non-blinded, single-centre trial, adult patients with pHPT were randomized to either 18FFluorocholine-PET-CT or ultrasonography and 99mTc Tc-MIBI-scintigraphy. Patients with previous thyroid or parathyroid surgery, planned concurrent thyroid surgery, lithium therapy, hereditary disease or severe renal insufficiency were not eligible. If the allocated localization investigations failed, 4D-CT was performed. The primary outcome was operation time in minutes. Secondary outcomes were biochemical cure; recurrent laryngeal nerve paresis; hypocalcaemia; persistent disease; sensitivity, specificity, PPV and NPV per-lesion and per-patient; total irradiation; total imaging and procedure cost. Results In all, 126 patients were included, of which 66 were randomized to 18FFluorocholine-PET-CT and 60 to conventional imaging (controls). 11 patients withdrew and 8 were excluded, after which, 59 patients remained in the PET group and 48 among the controls. 4D-CT was performed in 2 patients in the PET group, and in 19 among the controls. Median operation time was shorter and cure rate higher in the PET group compared to the conventional group, 26 (IQR 19–36) vs. 34.5 (20–48) minutes, p=0.042, and 100% vs. 91%, p=0.036. There were no adverse events. Conclusions 18FFluorocholine-PET-CT provides better preoperative localization in primary hyperparathyroidism, reducing operation time and improving cure rate compared to standard imaging with ultrasonography and 99mTcTc-MIBI-scintigraphy.

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