Localization of parathyroid adenomas with C11-methionine PET-CT

In primary hyperparathyroidism (pHPT) preoperative localization of parathyroid adenomas enables focussed unilateral parathyroidectomy. Ultrasound and sestamibi scintigraphy are the recommended standard procedures for primary diagnostics of pHPT and C-11 methionine positron emission tomography computed tomography (Met-PET/CT) is the latest technique for localization of hyperfunctioning parathyroid glands. This review presents the results of Met-PET/CT on the basis of a selective literature search using the keywords "primary hyperparathyroidism and methionine", "primary hyperparathyroidism and PET", "parathyroid adenomas and methionine" and "parathyroid adenomas and PET". Localization of single gland adenomas can be achieved with Met-PET/CT in 79-91 % of cases. The advantages of this procedure are a high sensitivity even in operations for recurrencies or concomitant thyroid nodules and an accurate detection even with atypical localizations. In multiglandular disease a localization of more than one hyperfunctioning gland remains difficult. Potential limitations of the method include the restricted availability and the relatively high costs of Met-PET/CT. Using Met-PET/CT hyperfunctioning parathyroid glands can be exactly localized in most patients with pHPT. Indications for this procedure are mostly when preoperative standard tests are negative and in parathyroid surgery for recurrencies.