Feasibility of Hyperfunctioning Parathyroid Gland Localization Using [18F]fluciclovine PET/CT
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To evaluate the ability of anti-1-amino-3-anti-1-amino-3-[18F]fluorocyclobutane-1-carboxylic acid ([18F]fluciclovine) positron emission tomography/X-ray computed tomography (PET/CT) in comparison to Technetium-99m 2-methoxy isobutyl isonitrile ([99mTc]sestamibi) single-photon emission computed tomography/CT (SPECT/CT) for the localization of hyperfunctioning parathyroid glands in patients with hyperparathyroidism.
Four patients with hyperparathyroidism underwent 60-minutes sequential neck and thorax PET/CT after [18F]fluciclovine (352 ± 28 MBq) injection. Lesion uptake and target-to-background ratios (TBR) were compared with [99mTc]sestamibi (798 ± 27 MBq) SPECT/CT in the same patient.
Both techniques detected 4/5 hyperfunctioning parathyroid glands identified at surgery. The highest [18F]fluciclovine uptake and TBRs were at 5–9 min with rapid washout. [99mTc]sestamibi had significantly higher TBRs compared with [18F]fluciclovine (5–9 min) for blood pool (10.9 ± 4.7 vs 1.3 ± 0.6; p < 0.01) and reference muscle backgrounds (5.8 ± 3.0 vs 1.7 ± 0.6; p < 0.01), with non-significant trend for thyroid tissue background (1.3 ± 0.5 vs 1.1 ± 0.5; p = 0.73).
Hyperfunctioning parathyroid glands can be detected on [18F]fluciclovine PET/CT at early imaging, but conspicuity (TBR) is better with [99mTc]sestamibi. [18F]fluciclovine PET/CT does not seem promising in the detection of hyperfunctioning parathyroid glands.
Key wordsHyperfunctioning parathyroid gland [18F]fluciclovine PET/CT SPECT/CT [99mTc]sestamibi
We gratefully acknowledge the contributions of Ronald Crowe, RPh, BCNP and the cyclotron/synthesis team from Emory University Center for Systems Imaging.
Compliance with Ethical Standards
This feasibility pilot study was approved by the institutional review board and was performed in compliance with Health Insurance Portability and Accountability Act (HIPPA).
Conflicts of Interest
Emory University and Dr. Mark Goodman are eligible to receive royalties for [18F]fluciclovine. Blue Earth Diagnostics Ltd. provided [18F]fluciclovine synthesis cassettes to Emory University for this project. Although not impacting this study, funding is or has been received from Blue Earth Diagnostics Ltd. and Nihon Medi-Physics Co. Ltd. through the Emory University Office of Sponsored Projects for other clinical trials using FACBC ([18F]fluciclovine).
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