Secondary Logo

Journal Logo

18F-Fluorocholine PET/CT Imaging of Brown Tumors in a Patient With Severe Primary Hyperparathyroidism

Zhang-Yin, Jules MD*; Gaujoux, Sébastien MD, PhD; Delbot, Thierry MD; Gauthé, Mathieu MD*; Talbot, Jean-Noël MD, PhD*

Clinical Nuclear Medicine: December 2019 - Volume 44 - Issue 12 - p 971–974
doi: 10.1097/RLU.0000000000002814
Interesting Images
Open

Brown tumors are rare skeletal anomalies occurring in patients with hyperparathyroidism and exposing patients to pathological fractures. We report the case of a 26-year-old woman with severe primary hyperparathyroidism (calcemia, 2.9 mmol/L; parathyroid hormone, 59 pmol/L) who underwent 18F-fluorocholine (FCH) PET/CT before parathyroidectomy. FCH PET localized the hyperfunctioning parathyroid gland and showed multiple foci in correspondence with bone lytic lesions on CT. Those lesions were not visible on the 99mTc-MIBI dual-phase scintigraphy. The pathology of one of the FCH-positive bone lesions corresponded to a brown tumor related to hyperparathyroidism.

From the *Department of Nuclear Medicine, Hôpital Tenon & Sorbonne Université

Department of Pancreato-Biliary and Endocrine Surgery, Hopital Cochin & Sorbonne Paris Cité

Department of Nuclear Medicine, Hopital Cochin, Paris, France.

Received for publication May 4, 2019; revision accepted August 5, 2019.

Conflicts of interest and sources of funding: none declared.

Correspondence to: Jules Zhang-Yin, MD, Médecine Nucléaire, Hôpital Tenon & Sorbonne Université, 4 Rue de la Chine, 75020, Paris, France. E-mail: tianyuzhang777@msn.com.

Online date: October 25, 2019

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

FIGURE 1

FIGURE 1

FIGURE 2

FIGURE 2

FIGURE 3

FIGURE 3

FIGURE 4

FIGURE 4

Back to Top | Article Outline

REFERENCES

1. Michaud L, Burgess A, Huchet V, et al. Is 18F-fluorocholine-positron emission tomography/computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism? J Clin Endocrinol Metab. 2014;99:4531–4536.
2. Lezaic L, Rep S, Sever MJ, et al. 18F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study. Eur J Nucl Med Mol Imaging. 2014;41:2083–2089.
3. Michaud L, Balogova S, Burgess A, et al. A pilot comparison of 18F-fluorocholine PET/CT, ultrasonography and 123I/99mTc-sestamibi dual-phase dual-isotope scintigraphy in the preoperative localization of hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism: influence of thyroid anomalies. Medicine (Baltimore). 2015;94:e1701.
4. Treglia G, Piccardo A, Imperiale A, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2019;46:751–765.
5. Prabhu M, Kumari G, Damle NA, et al. Comparability of early dynamic and conventional static imaging with 18F-fluorocholine PET/CT in a patient with primary hyperparathyroidism. Clin Nucl Med. 2018;43:e400–e401.
6. Morland D, Richard C, Godard F, et al. Temporal uptake patterns of 18F-fluorocholine among hyperfunctioning parathyroid glands. Clin Nucl Med. 2018;43:504–505.
7. Chew FS, Huang-Hellinger F. Brown tumor. AJR Am J Roentgenol. 1993;160:752.
8. Makras P, Anastasilakis AD. Bone disease in primary hyperparathyroidism. Metabolism. 2018;80:57–65.
9. Bilezikian JP, Bandeira L, Khan A, et al. Hyperparathyroidism. Lancet. 2018;391:168–178.
10. Dinauer PA, Balingit AG, Rivera JE. Tc-99m sestamibi imaging of brown tumors of primary hyperparathyroidism. Clin Nucl Med. 1996;21:192–196.
11. Gedik GK, Ata O, Karabagli P, et al. Differential diagnosis between secondary and tertiary hyperparathyroidism in a case of a giant-cell and brown tumor containing mass. Findings by 99mTc-MDP, 18F-FDG PET/CT and 99mTc-MIBI scans. Hell J Nucl Med. 2014;17:214–217.
    12. Zanglis A, Andreopoulos D, Zissimopoulos A, et al. Multiple brown tumors with Tc-99m MDP superscan appearance and negative Tc-99m MIBI uptake. Clin Nucl Med. 2006;31:640–643.
    13. van Baardwijk A, de Jong J, Arens A, et al. False-positive FDG-PET scan due to brown tumours. Eur J Nucl Med Mol Imaging. 2006;33:393–394.
    14. Hermoye A, Malghem J, Lecouvet F, et al. F-18 FDG PET/CT as a noninvasive diagnostic and follow-up tool in brown tumors due to secondary hyperparathyroidism. Clin Nucl Med. 2009;34:330–332.
    15. Gahier Penhoat M, Drui D, Ansquer C, et al. Contribution of 18-FDG PET/CT to brown tumor detection in a patient with primary hyperparathyroidism. Joint Bone Spine. 2017;84:209–212.
    16. García JR, Alvarez Moro FJ, Bassa P, et al. Brown tumours due to secondary hyperparathyroidism detected by 11C-choline PET/CT. Rev Esp Med Nucl Imagen Mol. 2016;35:209–210.
      17. Broos WAM, Wondergem M, van der Zant FM, et al. Tertiary hyperparathyroidism with renal osteodystrophy on 18F-fluorocholine PET/CT. Clin Nucl Med. 2018;43:766–768.
      18. Quak E, Blanchard D, Houdu B, et al. F18-choline PET/CT guided surgery in primary hyperparathyroidism when ultrasound and MIBI SPECT/CT are negative or inconclusive: the APACH1 study. Eur J Nucl Med Mol Imaging. 2018;45:658–666.
      19. Kluijfhout WP, Pasternak JD, Gosnell JE, et al. 18F-fluorocholine PET/MR imaging in patients with primary hyperparathyroidism and inconclusive conventional imaging: a prospective pilot study. Radiology. 2017;284:460–467.
      Keywords:

      18F-fluorocholine; PET/CT; 99mTc-MIBI; primary hyperparathyroidism; brown tumors

      Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.