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Detection of hyperfunctioning parathyroid tissue by PET/CT with 18F-Fluorocholine
Detección de tejido paratiroideo hiperfuncionante mediante PET/CT con 18F-Fluorocolina
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Se realizó gammagrafía tiroidea (A) y paratiroidea (B1 y B2), siguiendo el mismo protocolo que en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>. La gammagrafía paratiroidea se completó con una adquisición SPECT/TC (C) en la que, al igual que en el estudio planar, no hubo evidencia de hiperfunción paratiroidea. Del mismo modo, se realizaron 2 ecografías cervicales (a los 13 y 24 meses de la cirugía, respectivamente), que no mostraron lesiones significativas. En vista de la persistencia de la alteración bioquímica y de la negatividad de los estudios morfo-funcionales convencionales, se decidió realizar una PET/TC con <span class="elsevierStyleSup">18</span>F-fluorocolina (32 meses después de la cirugía, <a class="elsevierStyleCrossRef" href="#fig0015">fig. 3</a>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Villasboas-Rosciolesi, A. García-Burillo, O. González-López, E. Caubet-Busquet, J. 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"apellidos" => "Carrio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X18301008" "doi" => "10.1016/j.remn.2018.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X18301008?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918301034?idApp=UINPBA00004N" "url" => "/22538089/0000003800000002/v1_201903020621/S2253808918301034/v1_201903020621/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2253808918300533" "issn" => "22538089" "doi" => "10.1016/j.remnie.2018.07.001" "estado" => "S300" "fechaPublicacion" => "2019-03-01" "aid" => "994" "copyright" => "Sociedad Española de Medicina Nuclear e Imagen Molecular" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2019;38:116-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 14 "formatos" => array:2 [ "HTML" => 12 "PDF" => 2 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "<span class="elsevierStyleSup">99m</span>Tc-MAG3 SPECT/CT in a case of urolithiasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "117" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Spect/Tc con <span class="elsevierStyleSup">99m</span>Tc-MAG3 en un caso de urolitiasis" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1635 "Ancho" => 1500 "Tamanyo" => 133183 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) First 16<span class="elsevierStyleHsp" style=""></span>min acquisition. Ascending scintigraphic curves bilaterally which are typical of obstruction. Blue curve right kidney, red curve left kidney. (B) Second 16<span class="elsevierStyleHsp" style=""></span>min acquisition, administration of furosemide at minute 0 (F0) is performed. It is observed how the curves descend bilaterally after diuretic stimulation. Blue curve right kidney, red curve left kidney.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M.A. Ochoa-Figueroa, A. Davidsson, V. Sánchez-Rodríguez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M.A." "apellidos" => "Ochoa-Figueroa" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Davidsson" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Sánchez-Rodríguez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S2253654X1830074X" "doi" => "10.1016/j.remn.2018.05.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X1830074X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808918300533?idApp=UINPBA00004N" "url" => "/22538089/0000003800000002/v1_201903020621/S2253808918300533/v1_201903020621/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Detection of hyperfunctioning parathyroid tissue by PET/CT with <span class="elsevierStyleSup">18</span>F-Fluorocholine" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "118" "paginaFinal" => "120" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "D. Villasboas-Rosciolesi, A. García-Burillo, O. González-López, E. Caubet-Busquet, J. Castell-Conesa" "autores" => array:5 [ 0 => array:4 [ "nombre" => "D." "apellidos" => "Villasboas-Rosciolesi" "email" => array:1 [ 0 => "diego.villasboas@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "García-Burillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "O." "apellidos" => "González-López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "E." "apellidos" => "Caubet-Busquet" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Castell-Conesa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Endocrina, Hospital Universitari Vall d’Hebron, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Detección de tejido paratiroideo hiperfuncionante mediante PET/CT con <span class="elsevierStyleSup">18</span>F-Fluorocolina" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 1400 "Tamanyo" => 76714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Further imaging studies in the patient with persistent biochemical hyperparathyroidism (PTH: 177<span class="elsevierStyleHsp" style=""></span>pg/mL, calcium 11.5<span class="elsevierStyleHsp" style=""></span>mg/dL), 12 months after surgery were performed. Thyroid (A) and parathyroid (B1 and B2) scintigraphy were performed, same protocol as in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. A study was completed with acquisition of SPECT/CT (C), in which, as in planar images, no parathyroid hyperfunction was evident. Likewise, two cervical ultrasounds were performed (at 13 and 24 months after surgery) that did not show significant lesions.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In view of the persistence of the biochemical alteration and the negativity of the conventional morpho-functional studies, it was decided to perform a PET/CT study with <span class="elsevierStyleSup">18</span>F-Fluorocholine (32 months after the surgery, <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 39-year-old man being studied for cloxacillin allergy, without previous history, showed hypercalcemia (11.9<span class="elsevierStyleHsp" style=""></span>mg/dL). An extended analytical study showed the following values: calcium 11.9<span class="elsevierStyleHsp" style=""></span>mg/dL; phosphate: 3.1<span class="elsevierStyleHsp" style=""></span>mg/dL; calcidiol 21.8<span class="elsevierStyleHsp" style=""></span>ng/mL; paratirine (PTH) 144<span class="elsevierStyleHsp" style=""></span>pg/mL; urinary calcium 11.8<span class="elsevierStyleHsp" style=""></span>mg/dL; and urinary calcium excretion 177<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h. Upon the suspicion of primary hyperparathyroidism (PPH), a cervical ultrasound was requested that was inconclusive (adenopathy versus right parathyroid gland), and parathyroid scintigraphy (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) without evidence of parathyroid hyperfunction.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Minimally invasive surgery was performed with a biopsy taken from both right parathyroid glands (based on the sonographic findings). The intraoperative monitoring of PTH was: basal 175<span class="elsevierStyleHsp" style=""></span>pg/mL, 5<span class="elsevierStyleHsp" style=""></span>min 205<span class="elsevierStyleHsp" style=""></span>pg/mL and 10<span class="elsevierStyleHsp" style=""></span>min 220<span class="elsevierStyleHsp" style=""></span>pg/mL. The histopathological analysis of the biopsied specimens showed no evidence of adenoma or atypia. During follow-up, hyperparathyroidism persisted (PTH: 177<span class="elsevierStyleHsp" style=""></span>pg/mL, calcium 11.5<span class="elsevierStyleHsp" style=""></span>mg/dL), so a new scintigraphy was requested (12 months postoperatively, <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) and two cervical ultrasounds (13 and 24 months after the surgery) which were negative.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">In view of the biochemical persistence of the disease and negativity of conventional tests, a PET/CT with <span class="elsevierStyleSup">18</span>F-Fluorocholine was performed (32 months post-intervention, <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>), which showed a focal uptake (SUVmax: 7), posterior to the left inferior thyroid pole. After surgical exeresis, hyperplasia without atypia was confirmed. The analytical values at 15 days after reintervention were normal (calcium 9.5<span class="elsevierStyleHsp" style=""></span>mg/dL, parathyroid hormone: 29.3<span class="elsevierStyleHsp" style=""></span>pg/mL).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">HPP is a common endocrine disorder, characterized by an increase in PTH secretion by the parathyroid glands and leading to hypercalcemia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> Up to 84% of cases are caused by an adenoma; less frequently, a hyperplasia, a multiglandular disease and, exceptionally, a carcinoma.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> The preoperative identification of the lesion reduces complications and comorbidity.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Conventional localization techniques include ultrasound and <span class="elsevierStyleSup">99m</span>Tc-MIBI scintigraphy with a sensitivity of 63.2% and 80.3%, respectively.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,3</span></a> In cases where these techniques are negative, PET/CT with <span class="elsevierStyleSup">18</span>F-Fluorocholine is a good alternative, with a sensitivity of 91–92%,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a> if 11C-Methionine is not available (sensitivity 92%).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> In our case, the PET/CT allowed the correct localization and excision of the lesion.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In conclusion, PET/CT with <span class="elsevierStyleSup">18</span>F-Fluorocholine is a tool to be considered for the localization of hyperfunctioning parathyroid tissue in selected cases (hyperplasia, ectopic glands, cervical surgical history and negativity in conventional techniques).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Villasboas-Rosciolesi D, García-Burillo A, González-López O, Caubet-Busquet E, Castell-Conesa J. Detección de tejido paratiroideo hiperfuncionante mediante PET/CT con <span class="elsevierStyleSup">18</span>F-Fluorocolina. Rev Esp Med Nucl Imagen Mol. 2019;38:118–120.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 783 "Ancho" => 1400 "Tamanyo" => 102399 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">39-Year-old man with clinical suspicion of primary hyperparathyroidism (calcium 11.9<span class="elsevierStyleHsp" style=""></span>mg/dL, phosphate: 3.1<span class="elsevierStyleHsp" style=""></span>mg/dL, calcidiol 21.8<span class="elsevierStyleHsp" style=""></span>ng/mL and PTH 144<span class="elsevierStyleHsp" style=""></span>pg/mL), whose ultrasound study showed a hypoechoic image of 8<span class="elsevierStyleHsp" style=""></span>mm behind the right inferior thyroid pole, without internal vascularization (colour Doppler) suggestive of parathyroid gland versus lymph node image. (A) Anterior planar projection after 15<span class="elsevierStyleHsp" style=""></span>min of intravenous administration of 222<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">99m</span>Tc-Pertechnetate. (B) Anterior planar images after 15 min (B1) and 120 min (B2)<span class="elsevierStyleHsp" style=""></span>of intravenous administration of 666<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">99m</span>Tc-sestaMIBI. (C) Coronal and axial SPECT/CT images 60<span class="elsevierStyleHsp" style=""></span>min after the administration of the radiopharmaceutical. The study does not show the presence of hyperfunctioning parathyroid tissue. The patient underwent surgery, where the parathyroid glands presented a normal appearance, biopsy samples were taken from both right parathyroids; the histopathological analysis showed no evidence of the presence of adenoma or cellular atypia. The ultrasound image corresponded to a lymph node.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 1400 "Tamanyo" => 76714 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Further imaging studies in the patient with persistent biochemical hyperparathyroidism (PTH: 177<span class="elsevierStyleHsp" style=""></span>pg/mL, calcium 11.5<span class="elsevierStyleHsp" style=""></span>mg/dL), 12 months after surgery were performed. Thyroid (A) and parathyroid (B1 and B2) scintigraphy were performed, same protocol as in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. A study was completed with acquisition of SPECT/CT (C), in which, as in planar images, no parathyroid hyperfunction was evident. Likewise, two cervical ultrasounds were performed (at 13 and 24 months after surgery) that did not show significant lesions.</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In view of the persistence of the biochemical alteration and the negativity of the conventional morpho-functional studies, it was decided to perform a PET/CT study with <span class="elsevierStyleSup">18</span>F-Fluorocholine (32 months after the surgery, <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1260 "Ancho" => 1400 "Tamanyo" => 137512 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A PET/CT study with intravenous contrast at 60<span class="elsevierStyleHsp" style=""></span>min after intravenous administration of 370<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">18</span>F-Fluorocholine, in a patient with biochemical persistence of hyperparathyroidism after biopsy of both right parathyroid glands, was performed. (A) Coronal PET image in which a focal paramedial increase uptake (arrow) is observed; in the axial section (PET: B, CT: C and fusion: D) an increase in phospholipid metabolism can be localized in the left prevertebral region (solid black arrow in B, SUVmax: 7), this finding corresponds to a solid lesion that showed enhancement iodinated contrast (solid white arrow in C) in a left pre-vertebral and paraesophageal location. After surgery, the histopathological report revealed the existence of parathyroid hyperplasia, and the serum levels of calcium and parathyroid hormone normalized (9.5<span class="elsevierStyleHsp" style=""></span>mg/dL and 29.3<span class="elsevierStyleHsp" style=""></span>pg/mL, respectively).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enabling minimal invasive parathyroidectomy for patients with primary hyperparathyroidism using Tc-99m-sestamibi SPECT–CT, ultrasound and first results of <span class="elsevierStyleSup">18</span>F-fluorocholine PET–CT" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "W.P. Kluijfhout" 1 => "W.M. Vorselaars" 2 => "M.R. Vriens" 3 => "I.H. 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