Clinical Value of 18F -Fluorocholine PET in Localizing Parathyroid Lesions---Comparison with mTc-Sestamibi Scan

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Project title/計畫英文名

Project Number/計畫編號

MOST104-2314-B002-135

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

Website

link

Start date/計畫起

01-08-2015

Expected Completion/計畫迄

12-07-2016

摘要：副曱狀腺功能亢進是臨床常見的内分泌問題.初級副曱狀腺功能亢進症主要因為副曱狀腺赫爾蒙分泌過多，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.次級副曱狀腺功能亢進症則是因為低血鈣所引起副曱狀腺的生理反應，常見於維生素不足及長期接受洗腎的病人.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曱狀腺.99mTc-sestamibi (MIBI)加上頸部超因波是目前最廣泛使用的影像檢查.但是對於多顆副曱狀腺病灶，該兩項檢查的敏感度及特異度則明顯不足.近來有幾個報告使用膽鹼（choline)正子造影在評估攝護腺癌時意外發現副曱狀腺腺瘤的病例報告.”C或18F膽鹼（choline)是偵測攝護腺癌及肝細胞癌的分子探針.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曱狀腺組織内的phospholipid/Ca2+-dependent protein kinase活性也較退化的副曱狀腺組織高.以上這兩個機制都可導致膽鹼被功能亢進的副曱狀腺組織吸收.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曱狀腺的效益.還沒有針對99mTc-M旧丨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.因此我們計晝以這個前瞻性的研究來：1.比較頸部超音波，99mTc-M旧丨SPECT及18F-FCH正子造影運用在定位功能亢進的副曱狀腺病灶(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-M旧ISPECT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正子造影在副曱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: Hyperparathyroidism is a common endocrine disorder. Primary hyperparathyroidism is due to over-secretion of parathyroid hormone and subsequently hypercalcemia, hyperphosphatemia and osteoporosis with the prevalence of 1/500 in female and 1/2000 in male. In contrast, secondary hyperparathyroidism is due to physiological secretion of parathyroid hormone by the parathyroid glands in response to hypocalcemia. Surgical approach is the major treatment modality for these patients with hyperparathyroidism. Pre-operative localization of hyperfunctioning glands may lead to minimally invasive surgery. The most commonly used imaging modality for this purpose is 99mTc-sestamibi (M旧I), and supplemented by ultrasonography of the neck. However, the sensitivity and specificity is significantly lower in patients with multiple parathyroid lesions.Recently, some investigators reported cases of parathyroid adenoma discovered incidentally on choline PET images performed for prostate cancer. 11C or 18F-fluorocholine (FCH) is a PET probe used in imaging prostate cancer and hepatocellular carcinoma. As a phospholipid analog, choline is integrated 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 kinase was also higher in hyper-functioning parathyroid tissue than in atrophic parathyroid gland. Both mechanisms may be responsible for the uptake of choline tracers in hyper-functioning parathyroid tissue. Up to now, there are only 3 original reports with limited patients using choline PET in the evaluation of hyperparathyroidism. Yet, no study aims at 99mTc-M旧I and ultrasound negative group.We would like to perform this prospective study to1.compare the detection rates among ultrasonography, 99mTc-M旧I scan and 18F-FCH PET for localization of the parathyroid lesions including adenoma, hyperplasia or carcinoma;2.evaluate the usefulness of 18F-FCH PET as a second-line tracer in 99mTc-M旧丨 scan and ultrasonography negative patients.We hope the study results can not only have academic contribution but also apply clinically in the localization of hyperfunctioning parathyroid lesions before surgical intervention.

Keyword(s)

副曱狀腺功能亢進
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

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Clinical Value of 18F -Fluorocholine PET in Localizing Parathyroid Lesions---Comparison with mTc-Sestamibi Scan

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