Captación patológica con 18-Fluorocolina frente a 99mTc-MIBI en la localización de las glándulas paratiroides en el hiperparatiroidismo. Revisión sistemática y metanálisis
Resumen Introducción: La localización de las glándulas paratiroides patológicas en el hiperparatiroidismo usualmente se realiza mediante gammagrafía con 99mTc-sestamibi que incrementa su precisión al añadir la exploración ecográfica. La no localización de las glándulas paratiroides incrementa las dificultades para la extirpación quirúrgica. Para incrementar la detección de glándulas patológicas se utilizan otros trazadores radiactivos como la metionina, la fluorocolina o el 18F-flurpiridaz. Objetivo: Establecer si el PET/TC con 18-Fluorocolina en pacientes con hiperparatiroidismo incrementa el número captaciones comparada con la gammagrafía con 99mTc-sestamibi. Método: Revisión sistemática y metanálisis. Se analizaron dos subgrupos. Subgrupo 1: ensayos que comparan ambas técnicas como exploración inicial. Se seleccionaron 13 estudios que incluyen 1131 exploraciones (596 PET/TC con 18-Fluorocolina vs. 535 gammagrafía con 99mTc-sestamibi). Se realizó metanálisis siguiendo el modelo de efectos aleatorios y se calculó la odds ratio. Subgrupo 2: estudios que incluyen la 18-Fluorocolina como exploración de rescate en pacientes con estudio previo negativo con gammagrafía con 99mTc-sestamibi. Se seleccionaron 17 artículos que incluyen 412 exploraciones con 359 pacientes en los que al menos hubo una captación. Se realizó metanálisis de la prevalencia del número de pacientes en los que hubo al menos una captación aplicando el modelo de efectos aleatorios. Resultados: Subgrupo 1: El número de pacientes en los que se presenta al menos una captación es significativamente superior con las exploraciones con 18-Fluorocolina (OR 4.264, IC 95% 2.400-7.577). La prevalencia de captaciones con 18-Fluorocolina es de 0.91 [0.86, 0.95] y con sestamibi de 0.68 [0.56, 0.80]. Subgrupo 2: la prevalencia de captaciones entre pacientes con estudios MIBI negativos previos fue de 0.90 [0.87, 0.94]. La probabilidad de detección de ambas técnicas en este grupo llega al 0,98 El sesgo de publicación en los metanálisis es bajo. Discusión: Los protocolos con 18-Fluorocolina proporcionan mayor precisión, imágenes más claras, con una adquisición más rápida además de estar fácilmente disponible para la mayoría de los centros PET / CT. Conclusión: El estudio PET/TC con 18-Fluorocolina puede recomendarse como estudio para la localización de las glándulas paratiroides patológicas tras estudios con MIBI negativos.
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Michaud L, Burgess A, Huchet V, Lefèvre M, Tassart M, Ohnona J, et al. Is 18F-fluorocholine-positron emission tomography/ computerized tomography a new imaging tool for detecting hyperfunctioning parathyroid glands in primary or secondary hyperparathyroidism? J Clin Endocrinol Metab. 2014 Dec 1;99(12):4531-6. https://doi.org/10.1210/jc.2014-2821
Khafif A, Masalha M, Landsberg R, Domachevsky L, Bernstine H, Groshar D, et al. The role of F18-fluorocholine positron emission tomography/magnetic resonance imaging in localizing parathyroid adenomas. Eur Arch Oto-Rhino-Laryngology. 2019;276(5):1509-16. https://doi.org/10.1007/s00405-019-05301-2
Lezaic L, Rep S, Sever MJ, Kocjan T, Hocevar M, Fettich J. 18F-Fluorocholine PET/CT for localization of hyperfunctioning parathyroid tissue in primary hyperparathyroidism: a pilot study. Eur J Nucl Med Mol Imaging. 2014;41(11):2083-9. https://doi.org/10.1007/s00259-014-2837-0
Orevi M, Freedman N, Mishani E, Bocher M, Jacobson O, Krausz Y. Localization of parathyroid adenoma by 11C-Choline PET/CT preliminary results. Clin Nucl Med. 2014;39(12):1033-8. https://doi.org/10.1097/RLU.0000000000000607
Beheshti M, Hehenwarter L, Paymani Z, Rendl G, Imamovic L, Rettenbacher R, et al. 18F-Fluorocholine PET/CT in the assessment of primary hyperparathyroidism compared with 99mTc-MIBI or 99mTc-tetrofosmin SPECT/CT: a prospective dual-centre study in 100 patients. Eur J Nucl Med Mol Imaging. 2018 Sep 1;45(10):1762-71. https://doi.org/10.1007/s00259-018-3980-9
Araz, C. Soydal, E. Ozkan, M. Kir, E. İbis, S. Gullu MF, Erdogan, R. Emral ONK. The Efficacy of 18F Choline PET/CT in comparison to Tc99m MIBI SPECT/CT in the Localisation of Hyperfunctioning Parathyroid Gland in primary Hyperparathyroidism. Eur J Nucl Med Mol Imaging. 2018;45(Suppl. 1):S89-90. https://doi.org/10.1097/MNM.0000000000000899
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Bossert I, Chytiris S, Hodolic M, Croce L, Mansi L, Chiovato L, et al. PETC/CT with 18 F-Choline localizes hyperfunctioning parathyroid adenomas equally well in normocalcemic hyperparathyroidism as in overt hyperparathyroidism. J Endocrinol Invest. 2019 Apr 2;42(4):419-26. https://doi.org/10.1007/s40618-018-0931-z
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