18F-FCH PET/CT in persistent/recurrent pHPT
Research type
Research Study
Full title
18F-fluorocholine (FCH) PET/CT in persistent/recurrent primary hyperparathyroidism: correlation with choline kinase α expression.
IRAS ID
285883
Contact name
Tara Barwick
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
5 years, 0 months, 1 days
Research summary
Primary hyperparathyroidism (pHPT) requires parathyroidectomy (endocrine surgery) as the definitive treatment but persistent/recurrent pHPT has been reported in 4.9% of cases. Re-operative parathyroid surgery carries increased complication rates and overall reduced success. The threshold for surgery is higher and pre-operative imaging is considered essential.
Guidelines do not specify the imaging approach. Ultrasound and 99mTc-2-methoxyisobutylisonitrile (sestamibi) scan are considered first-line but are more likely to be negative in the re-do population. Parathyroid four-dimensional computed tomography is useful, but reporter dependent as image interpretation can be challenging, and radiation dose is high. Parathyroid angiography and selective venous sampling (ASVS) are invasive and thus reserved for challenging cases.
18F-fluorocholine (FCH) PET/CT is useful when conventional modalities (ultrasound and sestamibi) are equivocal or negative, or in challenging situations such as multi-gland disease. It works through the basis of assessing cell membrane turnover which is essential for normal function and increase in pathological states including in parathyroid adenomas. We wish to see if the level of choline uptake in parathyroid adenomas/small benign tumour of parathyroid glands on PET/CT correlates with a marker of cell membrane turnover in tissue (choline kinase alpha [CHKα]).
This retrospective data study will aim to correlate magnitude of tracer uptake on FCH PET/CT in parathyroid adenomas and the CHKα expression in subsequent surgical specimens. It will include patients who previously had a FCH PET/CT as part of routine clinical care and subsequent routine surgery to remove the adenoma.
We shall perform additional analysis using retrospective data of the surgical specimens to correlate the CHKα expression in tissue with the uptake on these FCH PET/CT studies. We will also assess the relationship of tracer uptake on imaging and CHKα expression with locations and weights of the abnormal glands and pre-operative parathyroid hormone levels.REC name
Wales REC 6
REC reference
22/WA/0179
Date of REC Opinion
8 Jun 2022
REC opinion
Favourable Opinion