September 27, 2025

Diagnostic Reliability and Clinical Impact of 11CCholine PET/CT for Detecting Hyperfunctioning Parathyroid Glands

Key Points

[11C]choline PET/CT achieved a patient-based sensitivity of 92.2% for detecting hyperfunctioning glands, emphasizing its diagnostic power.
With a positive predictive value of 98.3%, [11C]choline PET/CT significantly outperformed traditional imaging methods in pinpointing parathyroid adenomas.
Moderate interobserver agreement was demonstrated regarding gland localization, highlighting the need for improved interpretation criteria in imaging.
The cure rate after [11C]choline PET/CT-guided surgery was shown to be 84.1%, supporting the method's clinical efficacy in treating cHPT.

Abstract

11Ccholine PET/CT could become the preferred method for detecting hyperfunctioning parathyroid glands in patients with clinical hyperparathyroidism (cHPT), given its growing accessibility and superior diagnostic performance compared with conventional imaging. This study aimed to evaluate the robustness of 11Ccholine PET/CT in identifying and localizing hyperfunctioning parathyroid glands in preoperative settings. Methods: This retrospective study included patients with biochemically proven cHPT who underwent 11Ccholine PET/CT for preoperative localization of parathyroid adenomas. Parathyroid hormone levels, calcium metabolism, and previous scintigraphy and ultrasound results were collected for each patient, along with available histopathology results. Three reviewers evaluated the presence and anatomic localization of adenomas, and interobserver agreement was assessed. The diagnostic performance of 11Ccholine PET/CT was assessed exclusively in patients who underwent surgical resection or fine-needle aspiration biopsy of the suspected hyperfunctioning glands, using histopathologic results as the reference standard. Results: This study included 174 patients. Moderate interobserver agreement was reached regarding examination positivity (Fleiss κ, 0.636; 95% CI, 0.633–0.638) and gland localization (Fleiss κ, 0.656; 95% CI, 0.655–0.657). In the patient-based analysis, 11Ccholine PET/CT had a sensitivity of 92.2% and a positive predictive value of 98.3%; in the lesion-based analysis, the sensitivity reached 88.2%, with a positive predictive value of 96.8%. The cure rate of cHPT after 11Ccholine PET/CT–guided surgery was 84.1% (95% CI, 73.5%–91.3%). Conclusion: Our findings support the diagnostic efficacy of 11Ccholine PET/CT in patients with cHPT. Although the diagnostic performance is promising, the moderate interobserver agreement, particularly related to the accuracy of localizing ectopic parathyroid glands, calls for a refinement of interpretation criteria to improve the use of this imaging technique.

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