May 03, 2025
C-11 choline PET/CT has revolutionized treatment of hyperparathyroidism, especially in instances of re-operative parathyroidectomy. This technology, originally developed for imaging prostate cancer, was used at Mayo Clinic beginning in 2012. Later, this scan was incidentally found to also identify hyperfunctioning parathyroid tissue with high accuracy. Recent data show how effective this technology can be, even when conventional imaging methods using ultrasound, sestamibi, and 4D CT scan are inconclusive.
C-11 choline PET/CT
Scan shows right superior parathyroid adenoma located adjacent to the esophagus.
Trenton R. Foster, M.D., an endocrine surgeon at Mayo Clinic in Rochester, Minnesota, explains, "This technology can find enlarged parathyroid glands even in patients with nonlocalizing first line imaging. It is the most accurate parathyroid imaging test available."
Mayo Clinic colleagues recently reported the advantage of C-11 choline PET/CT in a study specifically evaluating a cohort of patients comprised primarily of having had prior failed operations and inconclusive conventional imaging. Even in this challenging group of patients, the use of C-11 choline PET/CT resulted in an impressive cure rate of 80% of patients who had positive scan results. The results of this study were published in Surgery.
Dr. Foster says, "This scan has helped surgeons at Mayo Clinic achieve curative resections in many patients who otherwise would not have been considered surgical candidates due to a lack of localization in scarred operative fields."
C-11 choline PET/CT remains a highly specialized scan. The technique requires an on-site cyclotron to produce the short-lived C-11 isotope, limiting its availability more broadly. Mayo Clinic is one of only a few institutions nationwide that is equipped with the technology and expertise to offer this option to its patients. The remarkable success of this scan has led endocrinologists and endocrine surgeons alike to increasingly rely on this technology as an essential component of their practice at Mayo Clinic.
For patients with difficult cases of primary hyperparathyroidism, referral for C-11 choline PET/CT may be a helpful step forward in their journey toward relief of this condition. Even if conventional imaging modalities are inconclusive, there is still promise that C-11 choline PET/CT may reveal an operative target. With more widespread use of this technology, an increasing number of patients are likely to benefit from this important step forward in parathyroid gland localization.
For more information
Saha S, et al. C11 choline PET/CT succeeds when conventional imaging for primary hyperparathyroidism fails. Surgery. 2023;173:117.
Refer a patient to Mayo Clinic.