Abstract
Objective: To compare the diagnostic efficacy of (11)C-choline PET/CT, neck ultrasonography, (99m)Tc-MIBI dual-phase planar scintigraphy, and (99m)Tc-MIBI SPECT/CT imaging in the diagnosis of primary hyperparathyroidism (PHPT). Methods: We conducted a retrospective analysis of 32 patients with PHPT who visited the Nuclear Medicine Department of Jilin University China-Japan Union Hospital between January 2019 and December 2022. All patients underwent (11)C-choline PET/CT, neck ultrasonography, (99m)Tc-MIBI dual-phase planar scintigraphy, and (99m)Tc-MIBI SPECT/CT examinations within two months before surgery. Sensitivity, specificity, positive predictive value, and negative predictive value of each imaging study were compared using postoperative pathology and follow-up results. Diagnostic efficacy was further analyzed using ROC curve analysis. Factors influencing on (99m)Tc-MIBI imaging were also investigated. Results: A total of 35 lesions were resected in the 32 patients. The diagnostic sensitivity of (11)C-choline PET/CT, neck ultrasonography, (99m)Tc-MIBI dual-phase planar scintigraphy, and (99m)Tc-MIBI SPECT/CT was 88.2%, 52.9%, 58.8%, and 67.6%, respectively. Specificity was 96.8%, 95.7%, 96.8%, and 95.7%, respectively. Positive predictive values were 90.9%, 81.8%, 86.9%, and 85.2%, respectively, and negative predictive values were 95.7%, 84.9%, 86.7%, and 89.1%, respectively. The areas under the ROC curve (AUC) were 0.925, 0.743, 0.778, and 0.817, respectively. Among them, (11)C-choline PET/CT had higher sensitivity and AUC than other imaging studies (p<0.05), while specificity, positive predictive value, and negative predictive value were similar (p>0.05). The positive group in (99m)Tc-MIBI SPECT/CT imaging had significantly larger lesion diameters than the negative group (P<0.05), while preoperative blood calcium and PTH showed no statistical differences (P>0.05). Conclusion: (11)C-choline PET/CT demonstrates superior preoperative diagnostic efficacy for PHPT compared to neck ultrasonography, (99m)Tc-MIBI dual-phase planar scintigraphy, and (99m)Tc-MIBI SPECT/CT. Lesion size may be the primary factor affecting the sensitivity of (99m)Tc-MIBI imaging.