Beyond conventional maging: the diagnostic performance of [<SUP>68</SUP>Ga]Ga-Trivehexin PET/CT for detecting hyperfunctioning parathyroid tissue in primary hyperparathyroidism
ANNALS OF NUCLEAR MEDICINE, vol.40, no.9, pp.1063-1072, 2026 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 40 Issue: 9
- Publication Date: 2026
- Doi Number: 10.1007/s12149-026-02220-1
- Journal Name: ANNALS OF NUCLEAR MEDICINE
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Aerospace Database, CINAHL, EMBASE, MEDLINE, Natural Science Collection (ProQuest), Biological Science Database (ProQuest), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Pharma Collection (ProQuest), Technology Collection (ProQuest)
- Page Numbers: pp.1063-1072
- Keywords: 4D-CT, MIBI scintigraphy, Parathyroid adenoma, PET/CT, Primary hyperparathyroidism, Ultrasonography, [⁶⁸Ga]Ga-Trivehexin
- Istanbul University Affiliated: Yes
Abstract
Aim The aim of this study was to evaluate the diagnostic performance and lesion localization capability of [Ga-6(8)]Ga-Trivehexin PET/CT for hyperfunctioning parathyroid tissue in primary hyperparathyroidism (P-HPT), through a retrospective analysis of data obtained from prospective studies conducted at two different centres, compared with the conventional preoperative imaging modalities [Tc-9(9)m]Tc-MIBI scintigraphy and neck ultrasonography (US). Materials and methods A total of 44 patients diagnosed with P-HPT based on clinical and laboratory parameters, who subsequently underwent cervical ultrasonographic evaluation, were included in this study. For all patients, serum parathyroid hormone (PTH), calcium (Ca), phosphorus (P), 25-OH vitamin D, urea, creatinine, glomerular filtration rate (GFR), and 24-hour urinary calcium values were recorded. Following cervical US examination, all participants underwent [Tc-9(9)m]Tc-MIBI scintigraphy as part of the routine preoperative work-up. Thereafter, to determine the diagnosis and localization of hyperfunctioning parathyroid tissue, [Ga-6(8)]Ga-Trivehexin PET/CT imaging was performed. All [Ga-6(8)]Ga-Trivehexin PET/CT data were visually assessed and quantitative measurements were obtained. [Ga-6(8)]Ga-Trivehexin PET/CT findings were evaluated in conjunction with PTH wash-out results, postoperative biochemical response confirmation, and histopathological assessment. Results Forty-four patients with P-HPT (median age, 52 years; range, 24-73) were included. [Ga-6(8)]Ga-Trivehexin PET/CT identified 37 hyperfunctioning parathyroid foci in 36 patients, corresponding to a patient-based detection rate of 81.8% (36/44). US and [Tc-9(9)m]Tc-MIBI scintigraphy detected lesions in 45.5% (20/44) and 47.7% (21/44) of patients, respectively, while in the 4D-CT subgroup (n = 20), a lesion was detected in 13 patients. Among 23 [Tc-9(9)m]Tc-MIBI-negative patients, [Ga-6(8)]Ga-Trivehexin PET/CT demonstrated at least one positive focus in 18, and on a lesion-based analysis, [Ga-6(8)]Ga-Trivehexin PET/CT confirmed 19 of 22 [Tc-9(9)m]Tc-MIBI -positive lesions while revealing additional foci in [Tc-9(9)m]Tc-MIBI-negative patients. According to the composite reference standard, [Ga-6(8)]Ga-Trivehexin PET/CT achieved a sensitivity of 97.3% and a PPV of 100%, clearly outperforming [Tc-9(9)m]Tc-MIBI scintigraphy and US. Conclusion In patients with primary hyperparathyroidism, [Ga-6(8)]Ga-Trivehexin PET/CT demonstrated significantly higher sensitivity than currently used standard imaging modalities. These findings suggest that [Ga-6(8)]Ga-Trivehexin PET/CT represents a promising diagnostic alternative, particularly in cases where conventional imaging is negative or inconclusive.