# 18F-NaF-PET/CT in patients with primary hyperparathyroidism and brown tumors

Graf, Carmen; Huellner, Martin; Tschopp, Oliver; Bode-Lesniewska, Beata; Schmid, Christoph (2020). 18F-NaF-PET/CT in patients with primary hyperparathyroidism and brown tumors. Journal of Bone and Mineral Metabolism, 38(3):299-309.

## Abstract

INTRODUCTION
Brown tumors (BT) are non-neoplastic bone lesions infrequently occurring in patients with long-standing severe hyperparathyroidism (HPT). BT may be identified and characterized using 18-F-sodium fluoride-positron-emission-tomography/computed tomography ($^{18}$F-NaF-PET/CT). We present a retrospective series of eight primary hyperparathyroidism (pHPT) patients with BT imaged with $^{18}$F-NaF-PET/CT.
MATERIALS AND METHODS
Imaging assessment included location, diameter, maximum standardized uptake value (SUV$_{max}$), metabolically active lesion volume (PET$_{vol}$) of BT, total metabolically active bone volume (TMB$_{vol}$) per patient and several computed tomography (CT) features of BT. Where appropriate, we analyzed the association between characteristic features of BT in $^{18}$F-NaF-PET/CT, histopathology, clinical symptomatology and laboratory parameters.
RESULTS
In our cohort of 8 patients (median age, 49 years, range, 26-73), 72 BT were found. The mean PET$_{vol}$ of BT was 89.48 cm$^{3}$ ± 122.81 cm$^{3}$ and the mean SUV$_{max}$ was 17.5 ± 7.8. The total PET$_{vol}$ of BT per patient correlated positively with serum calcium (r = 0.810, p = 0.015), and negatively with glomerular filtration rate (GFR) (r = - 0.762, p = 0.028). TMB$_{vol}$ correlated significantly with serum PTH (r = 0.810, p = 0.015), alkaline phosphatase (r = 0.762, p = 0.028), and duration of postoperative hospitalization (r = 0.826, p = 0.011, 24.3 days ± 19.8 days).
CONCLUSION
$^{18}$F-NaF-PET/CT is a valuable non-invasive whole-body imaging technique for the assessment of patients with pHPT and BT. TMB$_{vol}$ is associated with PTH and alkaline phosphatase, and the requirement for intense postoperative calcium substitution, which determines the duration of hospitalization.

## Abstract

INTRODUCTION
Brown tumors (BT) are non-neoplastic bone lesions infrequently occurring in patients with long-standing severe hyperparathyroidism (HPT). BT may be identified and characterized using 18-F-sodium fluoride-positron-emission-tomography/computed tomography ($^{18}$F-NaF-PET/CT). We present a retrospective series of eight primary hyperparathyroidism (pHPT) patients with BT imaged with $^{18}$F-NaF-PET/CT.
MATERIALS AND METHODS
Imaging assessment included location, diameter, maximum standardized uptake value (SUV$_{max}$), metabolically active lesion volume (PET$_{vol}$) of BT, total metabolically active bone volume (TMB$_{vol}$) per patient and several computed tomography (CT) features of BT. Where appropriate, we analyzed the association between characteristic features of BT in $^{18}$F-NaF-PET/CT, histopathology, clinical symptomatology and laboratory parameters.
RESULTS
In our cohort of 8 patients (median age, 49 years, range, 26-73), 72 BT were found. The mean PET$_{vol}$ of BT was 89.48 cm$^{3}$ ± 122.81 cm$^{3}$ and the mean SUV$_{max}$ was 17.5 ± 7.8. The total PET$_{vol}$ of BT per patient correlated positively with serum calcium (r = 0.810, p = 0.015), and negatively with glomerular filtration rate (GFR) (r = - 0.762, p = 0.028). TMB$_{vol}$ correlated significantly with serum PTH (r = 0.810, p = 0.015), alkaline phosphatase (r = 0.762, p = 0.028), and duration of postoperative hospitalization (r = 0.826, p = 0.011, 24.3 days ± 19.8 days).
CONCLUSION
$^{18}$F-NaF-PET/CT is a valuable non-invasive whole-body imaging technique for the assessment of patients with pHPT and BT. TMB$_{vol}$ is associated with PTH and alkaline phosphatase, and the requirement for intense postoperative calcium substitution, which determines the duration of hospitalization.

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