Assessment and Comparison of 18F-Fluorocholine PET and 99mTc-Sestamibi Scans in Identifying Parathyroid Adenomas: A Metaanalysis.

Background: Hyperparathyroidism is an endocrine disorder caused by one or more hyperfunctioning parathyroid glands. Current imaging consisting of ultrasound and 99mTc-Sestamibi (sestamibi) is imprecise, making localization difficult. 18F-Fluorocholine (FCH) Positron Emission Tomorography (PET) has recently shown promise in pre-surgical localization of parathyroid adenomas. The primary aim of this study is to summarize the sensitivities and specificities of studies using FCH PET to localize hyperparathyroidism. A secondary aim is to summarize a subset of studies in which sestamibi scans were also used, and to compare the performance of the two modalities. Methods: We searched MEDLINE and EMBASE databases following the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. Quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Twenty studies were included for quantitative assessment in our meta-analysis. A random effect model and a hierarchical summary receiver operating characteristic model was used to summarize the sensitivity of FCH PET in detecting abnormal parathyroid adenomas. We used the same methodology to assess sensitivity of sestamibi, as a comparison to FCH PET. Results: FCH PET had a high sensitivity for the detection of abnormal parathyroid adenomas 0.97 (0.96-0.98). In the subpopulation where both FCH and sestamibi were reported, FCH also had a higher sensitivity of 0.96 (0.94-0.98), compared with 0.54 (0.29-0.79) for sestamibi (p<0.001). Conclusion: FCH PET demonstrates high localization accuracy in patients with hyperparathyroidism. This meta-analysis supports the use of FCH in patients with hyperparathyroidism over sestamibi.