What does this research mean for the field?

18F-fluorocholine PET/CT provides superior sensitivity for the preoperative localization of parathyroid adenomas compared to conventional SPECT/CT, resulting in a reduced need for additional imaging and shorter operative times. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to determine the effectiveness of PET/CT versus SPECT/CT in locating parathyroid adenomas before surgery.

June 5, 2026

PET/CT or SPECT/CT in the Surgical Management of Primary Hyperparathyroidism

Key Points

This research aims to determine the effectiveness of PET/CT versus SPECT/CT in locating parathyroid adenomas before surgery.
Retrospective analysis of patients undergoing parathyroidectomy from January 2023 to July 2025.
Assessment of preoperative imaging accuracy between PET/CT and SPECT/CT, correlated with intraoperative findings.
Secondary outcomes included analysis of imaging necessity, operative duration, and postoperative hormone levels.
PET/CT showed 96% agreement with intraoperative findings compared to 75% for SPECT/CT, indicating superior sensitivity.
The need for additional imaging was significantly higher with SPECT/CT (32%) versus none required in the PET/CT group.
Operative times were longer with SPECT/CT (58 minutes) compared to PET/CT (41 minutes).

Abstract

Abstract Background Successful surgical management for primary hyperparathyroidism (pHPT) depends on accurate localization of parathyroid adenomas. Recent studies suggest that 18F-fluorocholine positron emission tomography/computed tomography (PET/CT) may outperform Tc99m-sestaMIBI single-photon emission (SPECT/CT) in sensitivity and accuracy. Aims This study aimed to compare the efficacy of PET/TC with conventional SPECT/TC in the preoperative localization of parathyroid adenomas. Methods All patients who underwent parathyroidectomy at our hospital between January 2023 and July 2025 were retrospectively reviewed, excluding those with multiple endocrine neoplasia type 1. Preoperative imaging pathways were analyzed and correlated with intraoperative and histopathological findings. Secondary outcomes included the need for additional imaging, operative time, requirement for bilateral exploration when adenomas were not localized, immediate postoperative parathyroid hormone (PTH) drop 50% and reoperation rates. Results Fifty-five patients were enrolled in the study, all assessed by an endocrinologist with a neck ultrasonography. Twenty-nine patients underwent SPECT/CT prior to surgery. Five of these required PET/CT due to negative/indeterminate SPECT/TC results. Twenty-one patients underwent PET/CT directly. PET/TC demonstrated significantly higher concordance with intraoperative and histopathological findings (96%) compared with SPECT/TC (75%), indicating superior localization sensitivity. Accordingly, the need for additional imaging was significantly higher after SPECT/TC (32%), whereas no further diagnostic analysis was required in the PET/TC group. Moreover, in the SPECT/TC group the operative time was significantly longer (58 min vs 41 min) and there was a trend toward more frequent bilateral exploration (24% vs 15%). Conversely, no significant differences were observed in postoperative PTH drop or reoperation rates, suggesting effective intraoperative adenoma identification even when imaging results were suboptimal. Conclusion PET/CT provides superior sensitivity for parathyroid adenoma localization when compared to SPECT/TC, resulting in fewer additional imaging and shorter operative times. These results support the use of PET/TC as a preferred diagnostic modality in preoperative evaluation of pHPT.

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