Assessment and Comparison of F-Fluorocholine PET and Tc-Sestamibi Scans in Identifying Parathyroid Adenomas: A Metaanalysis

Hyperparathyroidism is an endocrine disorder caused by one or more hyperfunctioning parathyroid glands. Current imaging consisting of ultrasound and Tc-sestamibi is imprecise, making localization difficult. F-fluorocholine (F-FCH) PET has recently shown promise in presurgical localization of parathyroid adenomas. The primary aim of this study was to summarize the sensitivities and specificities of studies using F-FCH PET to localize hyperparathyroidism. A secondary aim was to summarize a subset of studies in which Tc-sestamibi scans were also used and to compare the performance of the 2 modalities. We searched the MEDLINE and EMBASE databases following the PRISMA (Preferred Reporting Items for Systematic Review and Metaanalysis) statement. Quality was assessed using the QUADAS-2 tool (Quality Assessment of Diagnostic Accuracy Studies). Twenty studies were included for quantitative assessment in our metaanalysis. A random-effects model and a hierarchic summary receiver-operating-characteristic model was used to summarize the sensitivity of F-FCH PET in detecting abnormal parathyroid adenomas. We used the same methodology to assess sensitivity of Tc-sestamibi, as a comparison to F-FCH PET. F-FCH PET had a high sensitivity, 0.97 (range, 0.96-0.98), for the detection of abnormal parathyroid adenomas. In the subpopulation for which both F-FCH and Tc-sestamibi were reported, F-FCH also had a higher sensitivity, 0.96 (0.94-0.98), than the 0.54 (0.29-0.79) reported for Tc-sestamibi ( < 0.001). F-FCH PET demonstrates high localization accuracy in patients with hyperparathyroidism. This metaanalysis supports the use of F-FCH over Tc-sestamibi in patients with hyperparathyroidism.