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11C-methionine PET/CT in 99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis

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Abstract

Purpose

Scintigraphic localisation of parathyroid glands is often unsuccessful in patients with renal failure on chronic haemodialysis who have secondary hyperparathyroidism (HPT). The purpose of this study was to investigate the use of 11C-methionine PET/CT to detect hyperfunctioning parathyroid glands in patients with renal failure on chronic haemodialysis who had 99mTc-sestamibi-negative HPT.

Methods

11C-methionine PET/CT was performed in 18 patients (11 women and 7 men, aged 42–79 years; mean age 57.8 years) on haemodialysis for renal failure (2–14 years’ duration), with normo-, hypo- or hypercalcaemia and HPT not localised by either dual-tracer 99mTc-pertechnetate/99mTc-sestamibi subtraction scans or dual-phase 99mTc-sestamibi scans.

Results

In three of ten patients with normo- or hypocalcaemic HPT there was increased 11C-methionine accumulation in one gland. Seven of eight patients with hypercalcaemic HPT showed increased uptake: in five of these patients increased 11C-methionine accumulation was present in one gland, while in two it was demonstrated in two glands. All patients also had high-resolution ultrasound of the neck and were treated with subtotal parathyroidectomy, leaving a remnant of the smallest of the four glands. Regardless of their size, all glands with abnormal 11C-methionine parathyroid uptake were removed, and all demonstrated parathyroid hyperplasia. All patients developed post-parathyroidectomy hypoparathyroidism and one patient with normocalcaemic HPT relapsed 8 months after surgery.

Conclusion

These data suggest that 11C-methionine PET/CT may be used to identify hyperfunctioning parathyroid glands in non-primary HPT, and especially hypercalcaemic HPT, when conventional 99mTc-sestamibi imaging is non-localising.

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Authors and Affiliations

  1. Nuclear Medicine Service - PET Unit, S. Maria della Misericordia Hospital, Insituto Oncologico Veneto (IOV), Viale Tre Martiri, 140, 45100, Rovigo, Italy

    Domenico Rubello

  2. Nuclear Medicine Service - PET Unit, S. Orsola-Malpighi Hospital, University of Bologna Medical School, Bologna, Italy

    Stefano Fanti, Cristina Nanni, Mohsen Farsad, Paolo Castellucci, Stefano Boschi & Roberto Franchi

  3. Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy

    Giuliano Mariani

  4. Nuclear Medicine Department, Veterans Affairs Health System, Ann Arbor, MI, USA

    Lorraine M. Fig & Milton D. Gross

Authors
  1. Domenico Rubello
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  2. Stefano Fanti
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  3. Cristina Nanni
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  4. Mohsen Farsad
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  5. Paolo Castellucci
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  6. Stefano Boschi
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  7. Roberto Franchi
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  8. Giuliano Mariani
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  9. Lorraine M. Fig
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  10. Milton D. Gross
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Correspondence to Domenico Rubello.

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Rubello, D., Fanti, S., Nanni, C. et al. 11C-methionine PET/CT in 99mTc-sestamibi-negative hyperparathyroidism in patients with renal failure on chronic haemodialysis. Eur J Nucl Med Mol Imaging 33, 453–459 (2006). https://doi.org/10.1007/s00259-005-0008-z

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  • DOI: https://doi.org/10.1007/s00259-005-0008-z

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