Clinical Value of 18f -Fluorocholine Pet in Localizing Parathyroid Lesions: Comparison with 99mtc-Sestamibi Scan

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Project title/計畫英文名

Project Number/計畫編號

MOST105-2314-B002-090

Translated Name/計畫中文名

以氟-18-膽鹼正子造影精確找出副甲狀腺腫瘤的位置:與鎝-99m sestamibi比較

Project Principal Investigator/計畫主持人

RUOH-FANG YEN

Funding Organization

National Science and Technology Council

Co-Investigator(s)/共同執行人

楊偉勛,陳坤源,吳明勳

Website

link

Start date/計畫起

01-08-2016

Expected Completion/計畫迄

12-07-2017

摘要：原三年計畫已通過第一年計畫 (MST 104-2314-B-002 -135-)，至目前已收案21位，其中10位接受手術，初步結果顯示18F-FCH 正子造影偵測副甲狀病灶的能力較99mTc-MIBI SPECT及甲狀腺超音波高。現在提出第二、三年接續計畫(105/8-107/7)，希望能完成120位個案的收案，將分析18F-FCH 正子造影結果、甲狀腺超音波、99mTc-MIBI SPECT及外科手術的病理結果來比較。副甲狀腺功能亢進是臨床上常見的內分泌問題。初級副甲狀腺功能亢進症主要因為副甲狀腺荷爾蒙分泌過多，導致高血鈣、高血磷及骨鬆症，盛行率女性約1/500、男性約1/2000。目前的治療方式為微創外科手術切除，必須在手術前正確定位產生過度功能的副甲狀腺。99mTc-sestamibi (MIBI) 加上頸部超音波是目前最廣泛使用的影像檢查。但是該兩項檢查的敏感度及特異度都有不足之處。近來有幾個報告使用膽鹼 (choline) 正子造影在評估攝護腺癌時發現副甲狀腺腺瘤的病例報告。膽鹼 (choline) 是磷脂醯膽鹼 (phosphatidylcholine) 的主要成份，這些磷脂質又是細胞膜的重要成份。增生中細胞因為choline kinase 表現提升，使得膽鹼會與增生中細胞的細胞膜結合。除此之外，也有報告顯示在功能亢進的副甲狀腺組織內的 phospholipid/Ca2+-dependent proteinkinase 活性也較退化的副甲狀腺組織高。以上這兩個機制都可導致膽鹼被功能亢進的副甲狀腺組織吸收。截至目前為止, 只有三篇原著論文報告關於少數個案使用18F-fluorocholine (FCH) PET在偵測功能亢進的副甲狀腺的效益。還沒有針對99mTc-MIBI 及頸部超音波無法偵測到病灶之患者使用18F-FCH 的效益的研究。因此我們計畫將以這個前瞻性的研究來：1. 比較頸部超音波、99mTc-MIBI SPECT 及18F-FCH 正子造影運用在定位功能亢進的副甲狀腺病灶(包括腺瘤、增生組織或癌症) 的效益；2. 評估運用 18F-FCH 正子造影在99mTc-MIBI SPECT 無法偵測到病灶的患者的用途。希望本研究成果不僅具有學術價值，未來更可以在臨床上運用18F-FCH 正子造影在副甲狀腺功能亢進病灶的偵測，提供外科手術治療前正確的病灶定位。
Abstract: The 1st year project has been granted by MST 104-2314-B002-135-. To date, we have included 21patients with hyperparathyroidism. Ten of them had received surgical intervention. The preliminarydata suggest that 18F-FCH PET showed significantly higher sensitivity and specificity than 99mTc-MIBISPECT and thyroid echography. We submit this 2nd and 3rd year project and plan to include 120patients in total. The 18F-FCH PET results will be compared with the results of 99mTc-MIBI SPECT,thyroid echography and final pathology.Hyperparathyroidism is a common endocrine disorder. Primary hyperparathyroidism is due toover-secretion of parathyroid hormone and subsequently hypercalcemia, hyperphosphatemia andosteoporosis with the prevalence of 1/500 in female and 1/2000 in male. In contrast, secondaryhyperparathyroidism is due to physiological secretion of parathyroid hormone by the parathyroidglands in response to hypocalcemia. Surgical approach is the major treatment modality for thesepatients with hyperparathyroidism. Pre-operative localization of hyperfunctioning glands may lead tominimally invasive surgery. The most commonly used imaging modality for this purpose is99mTc-sestamibi (MIBI), and supplemented by ultrasonography of the neck. However, the sensitivityand specificity is significantly lower in patients with multiple parathyroid lesions.Recently, some investigators reported cases of parathyroid adenoma discovered incidentally oncholine PET images performed for prostate cancer. 11C or 18F-fluorocholine (FCH) is a PET probeused in imaging prostate cancer and hepatocellular carcinoma. As a phospholipid analog, choline isintegrated into newly synthesized membranes of proliferating cells by up-regulation of choline kinase.In addition, a previous study showed that the activity of phospholipid/Ca2+-dependent protein kinasewas also higher in hyper-functioning parathyroid tissue than in atrophic parathyroid gland. Bothmechanisms may be responsible for the uptake of choline tracers in hyper-functioning parathyroidtissue. Up to now, there are only 3 original reports with limited patients using choline PET in theevaluation of hyperparathyroidism. Yet, no study aims at 99mTc-MIBI and ultrasound negative group.We would like to perform this prospective study to3. compare the detection rates among ultrasonography, 99mTc-MIBI scan and 18F-FCH PET forlocalization of the parathyroid lesions including adenoma, hyperplasia or carcinoma;4. evaluate the usefulness of 18F-FCH PET as a second-line tracer in 99mTc-MIBI scan andultrasonography negative patients.We hope the study results can not only have academic contribution but also apply clinically in thelocalization of hyperfunctioning parathyroid lesions before surgical intervention.

Keyword(s)

副甲狀腺功能亢進
18F-氟膽鹼
正子造影
99mTc-sestamibi
單光子斷層造影
頸部超音波
Hyperparathyroidism
18F-fluorocholine
PET
99mTc-sestamibi
SPECT
ultrosounography

DSpace CRIS

Clinical Value of 18f -Fluorocholine Pet in Localizing Parathyroid Lesions: Comparison with 99mtc-Sestamibi Scan

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