REGIONAL BODY FDG-PET IN POSTOPERATIVE RECURRENT HYPERPARATHYROIDISM

Purpose: The use of preoperative imaging studies in patients with pers istent or recurrent hyperparathyroidism after initial operation is gen erally accepted to improve the success rate and minimize the morbidity from reoperative surgery. The purpose of this study was to define the performance of FDG-PET for the localization of hyperfunctioning parat hyroid tissue prior to reoperation. Method: Twenty patients with bioch emical evidence of recurrent or persistent hyperparathyroidism followi ng previous neck surgery were investigated. Regional body PET imaging of the neck and upper chest (axial field of view 27.5 cm) was acquired 45 min after 5-10 mCi FDG was given intravenously. Results: Subsequen t surgery revealed solitary parathyroid adenomas in 14 patients, seven hyperplastic glands in 2 patients, and parathyroid carcinoma in 1 pat ient. FDG-PET correctly identified 79% (11/14) of the parathyroid aden omas, 29% (2/7) of the hyperplastic glands, and the parathyroid carcin oma. FDG-PET was negative in 79% (30/38) of the surgically identified normal parathyroid glands, Eight false-positive findings led to a posi tive predictive value of 64%. Conclusion: These preliminary data sugge st that regional body FDG-PET is a promising procedure in the evaluati on of patients with persistent or recurrent postoperative hyperparathy roidism.