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Dual-Time-Point 18F-Fluorocholine PET/CT Improves Characterization of Thyroid Nodules in Patients Referred for Primary Hyperparathyroidism

2021; Lippincott Williams & Wilkins; Volume: 46; Issue: 12 Linguagem: Inglês

10.1097/rlu.0000000000003904

1536-0229

Jacob Bani, David Morland, F. Hubelé, Mihaela Ignat, Adrien Latgé, K. Bourahla, M. Zalzali, Michel Vix, David Taïeb, Alessio Impériale,

Medical Imaging and Pathology Studies

Purpose Thyroid nodules frequently coexist with primary hyperparathyroidism (pHPT). Because of the increasing use of 18 F-fluorocholine ( 18 F-FCH) PET/CT in patients with pHPT, evaluation of its clinical utility for thyroid nodules characterization in this population is of paramount importance. Herein, we investigate the value of dual-point 18 F-FCH PET/CT in the diagnosis of thyroid cancer in patients referred for pHPT imaging who have thyroid nodules. Patients and Methods All pHPT patients who underwent a dual-time point 18 F-FCH PET/CT (at 5 and 60 minutes postinjection) between July 2019 and December 2020 were analyzed. Only those with a thyroid nodule greater than 10-mm and pathological analysis (criterion standard) were included. Nodule-to-thyroid SUV max ratio was calculated at the 2 study points, as well as the 18 F-FCH washout index (WO%). Results Twenty-seven patients (32 nodules) were included in this study. The final diagnoses were as follows: 27 benign nodules including 2 NIFTPs (noninvasive follicular thyroid neoplasm with papillary-like nuclear features) and 5 cancers of follicular origin. Early uptake ratio was significantly higher in malignant lesions than in benign nodules ( P = 0.0008). Thyroid cancers were also characterized by a marked 18 F-FCH washout index (WO% benign vs cancer: 2.9% ± 4.1% vs 45.5% ± 13.4%, P = 0.0001). Using a WO% threshold of 22.1%, 25/27 benign nodules and 5/5 malignant lesions were accurately classified (sensitivity of 100%, specificity of 92.6%, positive predictive value of 71.4%, and negative predictive value of 100%). The false-positive findings were related to the 2 NIFTPs that share similarities with thyroid cancer. Conclusions Our preliminary results suggest to perform a dual-time-point PET/CT acquisition protocol in pHPT patients with uncharacterized centimeter thyroid nodules. However, the real impact of these promising results should be assessed by prospective studies on a larger cohort of patients.