MON-312 - Use of FCH PET/CT in Primary Hyperparathyroidism Due to Multiple Endocrine Neoplasia Type 1 - A Systematic Review

AIM
Primary hyperparathyroidism (PHPT) is characterized by hypercalcemia with elevated or inappropriately normal parathyroid hormone levels. A hereditary basis is seen in 10-15% of cases, most commonly due to MEN1 syndrome. Accurate preoperative localization of parathyroid adenoma(s) is central to successful surgical management of PHPT; however, there is no consensus regarding imaging for those with MEN1 syndrome. Recent publications have shown the promising nature of [18F]-Fluorocholine (FCH) PET/CT imaging in non-hereditary PHPT. This review will explore the role of FCH PET/CT in the preoperative localization of PHPT due to MEN1 syndrome.

METHODS
A systematic review was completed in accordance with PRISMA guidelines. A search of Cochrane, EMBASE and PubMed was performed from 2014 (date of the first publication describing FCH PET/CT) to present with relevant key terms including “MEN1”, “primary hyperparathyroidism” and “FCH PET/CT”. Studies describing the use of FCH PET/CT in patients with MEN1-associated PHPT were included.

RESULTS
374 papers were identified, with 10 meeting the inclusion criteria, comprising six retrospective studies and four case reports. Use of FCH PET/CT was reported to localise additional parathyroid lesions in five out of ten studies, while the remaining five papers stated an increased specificity (ranging from 50-98.75%) and sensitivity (ranging from 73-96.2%) compared to conventional parathyroid imaging techniques (sestamibi SPECT/CT, 4DCT, neck ultrasound). However, most studies were retrospective, included a small patient cohort, and administered heterogenous FCH PET/CT protocols, reducing comparability.

CONCLUSION
FCH PET/CT is a useful imaging technique to localize abnormal parathyroid tissue in MEN1-associated PHPT. Larger prospective trials, including a cost-effective analysis, would be beneficial to further define the role of FCH PET/CT in this population.

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