¹⁸F-Fluorocholine PET/CT, Tc-99m-MIBI and TC-99m-MDP SPECT/CT in Tertiary Hyperparathyroidism with Renal Osteodystrophy

• Main Authors: Cristina Ferrari, Valentina Lavelli, Giulia Santo, Maria Teresa Frugis, Francesca Iuele, Giuseppe Rubini, Angela Sardaro
• Format: Article
• Language: English
• Published: MDPI AG 2020-10-01
• Series: Diagnostics
• Subjects: tertiary hyperparathyroidism; renal osteodystrophy; dual-phase Tc-99m-MIBI; ¹⁸F-fluorocholine; positron emission tomography/computed tomography; Tc-99m-MDP
• Online Access: https://www.mdpi.com/2075-4418/10/10/851
• ISSN: 2075-4418

Tertiary hyperparathyroidism (HPT) is a metabolic disorder characterized by the semi-autonomous hypersecretion of parathyroid hormone (PTH), leading to hypercalcemia. It can be the end result of persistent secondary hyperparathyroidism and is most commonly observed in patients with long-standing chronic kidney disease (CKD) and often after renal transplantation. Untreated HPT can lead to progressive bone disease, fibrocystic osteitis, and soft-tissue calcifications, along with other severe complications. In the 2009 Kidney Disease Improving Global Outcomes (KDIGO) guidelines, CKD-Mineral and Bone Disorder (CKD-MBD) is used to describe the broader clinical syndrome encompassing mineral, bone, and calcific cardiovascular abnormalities that develop as a complication of CKD. We report a 62-year-old female with a severe HPT evolved from advanced chronic kidney disease (stage 5D, KDIGO). Patient was evaluated with multimodality nuclear medicine functional imaging to assess hyperfunctioning parathyroid glands and bone lesions. Tc-99m-methoxyisobutylisonitrile (MIBI) dual-phase scintigraphy, Tc-99m-methylenediphosphonate (MDP) bone scan and ¹⁸F-Fluorocholine positron emission tomography/computed tomography (¹⁸F-FCH PET/CT) were performed before surgery.