PARA-PET: a randomised trial of [<sup>18</sup>F]fluorocholine PET/CT vs conventional imaging for primary hyperparathyroidism — ASN Events
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  3. PARA-PET: a randomised trial of [18F]fluorocholine PET/CT vs conventional imaging for primary hyperparathyroidism

PARA-PET: a randomised trial of [18F]fluorocholine PET/CT vs conventional imaging for primary hyperparathyroidism (#400)

Elizabeth Wootton 1 2 , Clement Wong 2 3 , Peter Donovan 1 2 , Don SA McLeod 1 2 , Mathis Grossmann 4 5 , Samuel Kyle 1 2 6 , Anita Pelecanos 7 , Louisa Collins 8 , Roslyn Francis 2 9 , David A Pattison 2 9
  1. Endocrinology and Diabetes, RBWH, Brisbane, QLD, Australia
  2. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
  3. Endocrine Surgery, RBWH, Brisbane, QLD, Australia
  4. Endocrinology and Diabetes, Austin Health, Melbourne, VIC, Australia
  5. Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
  6. Medical Imaging, RBWH, Brisbane, QLD, Australia
  7. Statistical Unit, QIMR Berghofer, Brisbane, QLD, Australia
  8. Health Economics, Cancer Council Queensland, Brisbane, QLD, Australia
  9. Nuclear Medicine & PET Services, RBWH, Brisbane, QLD, Australia

Aims

[18F]Fluorocholine (FCH) PET/CT is a novel modality for parathyroid adenoma localisation offering several advantages over conventional imaging techniques. In predominantly small and retrospective studies, FCH PET/CT demonstrates higher accuracy (particularly for multiglandular disease), lower radiation exposure and shorter imaging time when compared with neck ultrasound (US), sestamibi SPECT/CT and four-dimensional CT (4DCT) (1,2). Patient satisfaction, cost effectiveness and environmental impact of parathyroid imaging strategies are largely unknown. PARA-PET aims to evaluate whether FCH PET/CT is non-inferior to conventional imaging in management impact for primary hyperparathyroidism, defined by change in intended surgical approach from bilateral neck exploration to minimally invasive targeted parathyroidectomy.

 

Methods

134 patients with primary hyperparathyroidism referred for surgery at a single centre will receive FCH PET/CT in addition to conventional imaging with neck US, sestamibi SPECT/CT and 4DCT. All imaging modalities will be reviewed at a monthly multidisciplinary meeting, attended by representatives from Endocrinology, Endocrine Surgery, Nuclear Medicine and Radiology. Participants will be randomised 1:1 to the order of diagnostic strategy assessment (FCH PET/CT vs conventional imaging), with interpretation blinded to alternative imaging arm results. The intended surgical approach will be prospectively documented. Clinical outcomes will be followed up at one and six months’ post-surgery. Additional analyses will include accuracy, patient satisfaction, cost effectiveness and environmental impact of each imaging technique.

 

Conclusion

This will be the first randomised blinded prospective trial to assess the management impact of FCH PET/CT compared to neck US, sestamibi SPECT/CT and 4DCT, and will provide high quality evidence guiding its use in a real-world setting. PARAPET is open for recruitment at the Royal Brisbane and Women’s Hospital, having enrolled 82 participants to date.

  1. Morris MA, Saboury B, Ahlman M, et al. Parathyroid Imaging: Past, Present, and Future. Front Endocrinol (Lausanne). 2021;12:760419. doi:10.3389/fendo.2021.760419
  2. Quak E, Cavarec M, Ciappuccini R, Girault G, Rouzier R, Lequesne J. Detection, resection and cure: a systematic review and meta-analysis of 18F-choline PET in primary hyperparathyroidism. Quarterly Journal of Nuclear Medicine and Molecular Imaging. 2023;67(2):122-129. doi:10.23736/S1824-4785.23.03512-4