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Oh SW, Park S, Chong A, Kim K, Bang JI, Seo Y, Hong CM, Lee SW. Nuclear Medicine Imaging in Differentiated Thyroid Cancer: Summary of the Korean Thyroid Association Guidelines 2024 from Nuclear Medicine Perspective, Part-I. Nucl Med Mol Imaging 2025; 59:1-7. [PMID: 39881973 PMCID: PMC11772645 DOI: 10.1007/s13139-024-00885-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Revised: 09/25/2024] [Accepted: 09/26/2024] [Indexed: 01/31/2025] Open
Abstract
Thyroid cancer, one of the most common endocrine tumors, generally has a favorable prognosis but remains a significant medical and societal concern due to its high incidence. Early diagnosis and treatment of differentiated thyroid cancer (DTC) significantly affect long-term outcomes, requiring the selection and application of appropriate initial treatments to improve prognosis and quality of life. Recent advances in technology and health information systems have enhanced our understanding of the molecular genetics of thyroid cancer, facilitating the identification of aggressive subgroups and enabling the accumulation of research on risk factors through big data. The Korean Thyroid Association (KTA) has revised the "KTA Guidelines on the Management of Differentiated Thyroid Cancers 2024" to incorporate these advances, which were developed by a multidisciplinary team and underwent extensive review and approval processes by various academic societies. This article summarizes the 2024 KTA guidelines for nuclear medicine imaging in patients with DTC, written by the Nuclear Medicine members of the KTA Guideline Committee, and covers 18F-FDG PET/CT and radioiodine imaging with SPECT/CT in the management of DTC.
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Affiliation(s)
- So Won Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center , Seoul, Republic of Korea
| | - Sohyun Park
- Department of Nuclear Medicine, National Cancer Center, Goyang, Republic of Korea
| | - Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea
| | - Youngduk Seo
- Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Chae Moon Hong
- Department of Nuclear Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Mihailović J. Pre-Treatment and Post-Treatment I-131 Imaging in Differentiated Thyroid Carcinoma. J Clin Med 2024; 13:1984. [PMID: 38610749 PMCID: PMC11012677 DOI: 10.3390/jcm13071984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Radioiodine imaging in initial perioperative settings, after the total thyroidectomy, includes pre-treatment and post-treatment radioiodine imaging. While the benefit of post-treatment whole-body imaging (PT-WBI) is well established, the role of diagnostic whole-body imaging (dx WBI), prior to radioiodine (I-131) ablative or therapeutic doses, is controversial. Dx WBI has been abandoned in most nuclear medicine centers long ago. Planar low-dose dxWBI provides the volume of postoperative thyroid remnants, but it cannot detect occult metastatic foci in the neck. The modern integrated multimodality, i.e., SPECT/CT imaging, provides three dimensional images and accurate anatomic/metabolic data. This hybrid technology offers better spatial resolution but not better sensitivity. Dx WBI has low theranostic power because of the radioiodine indifference and low detection sensitivity for small-volume nodal disease in the neck. Since dx WBI cannot clarify the paratracheal cervical uptake, thyroid remnants may be easily misinterpreted as nodal disease, leading to a false N upstaging (from N0 stage to N1 stage) in DTC patients. Post-ablation I-131 imaging has a significant role in the initial staging of radioiodine-avid DTC and in the identification of non-radioiodine avid tumors. Additionally, SPECT/CT in the post-treatment setting provides more accurate initial TNM staging and better risk stratification of DTC patients. Post-treatment I-131 imaging is obligatory and must be performed in all DTC patients who receive radioiodine treatment.
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Affiliation(s)
- Jasna Mihailović
- Department of Nuclear Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; ; Tel.: +381-63-526835
- Division of Nuclear Medicine, Oncology Institute of Vojvodine, Put dr Goldmana 4, 21204 Sremska Kamenica, Serbia
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Chong A, Seo Y, Bang JI, Park S, Kim K, Hong CM, Choi M, Oh SW, Lee SW. Clinical Implications of Adding SPECT/CT to Radioiodine Whole-Body Scan in Patients With Differentiated Thyroid Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2024; 49:215-225. [PMID: 38048517 DOI: 10.1097/rlu.0000000000004953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE This study aimed to determine the usefulness of adding SPECT/CT to radioiodine whole-body scans (WBSs) for the treatment of differentiated thyroid cancer (DTC). PATIENTS AND METHODS A systematic review and meta-analysis were performed following the PRISMA guidelines (PROSPERO registration: CRD42022341732) to compare the feasibility of conclusive readings and the frequency of changes in treatment plans in patients with DTC undergoing WBS + SPECT/CT versus WBS. MEDLINE, EMBASE, and Cochrane databases were searched to identify relevant articles concerning thyroid cancer, radioactive iodine, and SPECT/CT or SPECT, published before August 16, 2023. Studies not comparing WBS + SPECT/CT with WBS, those lacking target outcomes, and those not involving human subjects were excluded. The risk of bias was assessed using the RoBANS 2.0 (Risk of Bias Assessment Tool for Nonrandomized Studies) tool. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) system was used to evaluate the quality of evidence and strength of recommendations. RESULTS A total of 30 studies (prospective n = 9, retrospective n = 21) were included in the meta-analyses. Adding SPECT/CT to WBS was shown to increase conclusive readings for cervical lesions, extracervical lesions, and all regions. Lesion-based analyses showed improvements of 14%, 20%, and 18%, respectively, whereas scan-based analyses showed improvements of 27%, 9%, and 34%. The addition of SPECT/CT to WBS led to changes in 30% of treatment plans after diagnostic scans and 9% of treatment plans after posttherapeutic scans. The quality of evidence and strength of recommendations were low. CONCLUSIONS Compelling evidence demonstrates that the addition of SPECT/CT to WBS improves lesion localization, diagnostic performance, and therapy plan for patients with DTC.
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Affiliation(s)
- Ari Chong
- From the Department of Nuclear Medicine, Chosun University, College of Medicine and Chosun University Hospital, Gwangju
| | - Youngduk Seo
- Department of Nuclear Medicine, Chungnam National University Sejong Hospital, Sejong
| | - Ji-In Bang
- Department of Nuclear Medicine, CHA Bundang Medical Center, CHA University, Pocheon
| | - Sohyun Park
- Department of Nuclear Medicine, Hospital, National Cancer Center, Goyang
| | - Keunyoung Kim
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital and School of Medicine, Pusan National University, Busan
| | - Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, Daegu
| | - Miyoung Choi
- Division of Health Technology Assessment Research, National Evidence-Based Healthcare Collaborating Agency
| | - So Won Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul
| | - Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University, School of Medicine and Chilgok Hospital, Daegu, South Korea
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Marongiu A, Nuvoli S, De Vito A, Rondini M, Spanu A, Madeddu G. A Comparative Follow-Up Study of Patients with Papillary Thyroid Carcinoma Associated or Not with Graves' Disease. Diagnostics (Basel) 2022; 12:diagnostics12112801. [PMID: 36428861 PMCID: PMC9689017 DOI: 10.3390/diagnostics12112801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022] Open
Abstract
Whether papillary carcinoma (PC) behavior is more aggressive in Graves’ disease (GD) patients than PC cases without GD is controversial. We retrospectively enrolled 33 thyroidectomized PC/GD patients during long-term follow-up, 23/33 without risk factors at surgery, and 18/33 microcarcinomas; 312 PC euthyroid-matched patients without risk factors served as controls. A total of 14/33 (42.4%) PC/GD patients, 4 with and 10 without risk factors at diagnosis, 6 with microcarcinoma, underwent metastases during follow-up. In controls, metastases in 21/312 (6.7%) were ascertained. Considering 10/23 PC/GD patients and 21/312 controls without risk factors who developed metastases, univariate analysis showed that there was an increased risk of metastasis appearance for PC/GD cases (p < 0.001). Disease-free survival (DFS) was significantly (p < 0.0001, log-rank test) shorter in PC/GD patients than in controls. Significantly more elevated aggressiveness in 6/18 PC/GD patients with microcarcinoma than in controls was also ascertained with shorter DFS. Thus, in the present study, PC/GD had aggressive behavior during follow-up also when carcinoma characteristics were favorable and some cases were microcarcinomas. GD and non-GD patient comparison in the cases without risk factors at diagnosis showed an increased risk to develop metastases in GD during follow-up, suggesting that GD alone might be a tumor aggressiveness predictive factor in these cases.
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Affiliation(s)
- Andrea Marongiu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Susanna Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Andrea De Vito
- Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Maria Rondini
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
- Correspondence:
| | - Giuseppe Madeddu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, 07100 Sassari, Italy
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Elisei R, Agate L, Mazzarri S, Bottici V, Guidoccio F, Molinaro E, Boni G, Ferdeghini M, Mariani G. Radionuclide Therapy of Thyroid Tumors. NUCLEAR ONCOLOGY 2022:1381-1429. [DOI: 10.1007/978-3-031-05494-5_49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Gamma camera imaging in differentiated thyroid cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00195-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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The Diagnostic Usefulness of 131I-SPECT/CT at Both Radioiodine Ablation and during Long-Term Follow-Up in Patients Thyroidectomized for Differentiated Thyroid Carcinoma: Analysis of Tissue Risk Factors Ascertained at Surgery and Correlated with Metastasis Appearance. Diagnostics (Basel) 2021; 11:diagnostics11081504. [PMID: 34441438 PMCID: PMC8391408 DOI: 10.3390/diagnostics11081504] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 01/01/2023] Open
Abstract
131I Single-photon emission computerized tomography/computerized tomography (SPECT/CT) in the management of patients thyroidectomized for differentiated thyroid carcinoma (DTC) was further investigated. Retrospectively, 106 consecutive DTC patients were enrolled at the first radioiodine ablation, 24 at high risk (H), 61 at low risk (L) and 21 at very low risk (VL). 131I whole-body scan (WBS) and SPECT/CT were performed after therapeutic doses using a hybrid dual-head gamma camera. At ablation, SPECT/CT correctly classified 49 metastases in 17/106 patients with a significantly (p < 0.001) more elevated number than WBS which evidenced 32/49 foci in 13/17 cases. In this case, 86/106 patients could be monitored in the follow-up including 13/17 cases with metastases already at post-therapeutic scans. SPECT/CT after radioiodine diagnostic doses more correctly than WBS ascertained disease progression in 4/13 patients, stable disease in other 4/13 cases and disease improvement in the remaining 5/13 cases. Further 13/86 patients with only residues at post-therapeutic scans showed at SPECT/CT 16 neck lymph node (LN) metastases, three unclear and 13 occult at WBS. Significant involvement of some tissue risk factors with metastasis appearance was observed, such as minimal extrathyroid tumor extension and neck LN metastases. These risk factors should be carefully considered in DTC patient follow-up where 131I-SPECT/CT routinely use is suggested as a support tool of WBS.
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Neck lymph node metastasis detection in patients with differentiated thyroid carcinoma (DTC) in long-term follow-up: a 131I-SPECT/CT study. BMC Cancer 2020; 20:239. [PMID: 32197595 PMCID: PMC7083046 DOI: 10.1186/s12885-020-06744-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background The identification of neck lymph node (LN) metastases represents a very important issue in the management of patients with differentiated thyroid carcinoma (DTC). To this purpose, in the present study, we used 131I-SPECT/CT as a diagnostic imaging procedure. Methods A consecutive series of 224 DTC patients with ascertained neck radioiodine-avid foci at 131I-SPECT/CT during long-term follow-up was evaluated. All patients had already undergone total thyroidectomy and radioiodine therapy and had been classified as follows: 62 at high risk (H), 64 at low risk (L) and 98 at very low risk (VL). 131I-Whole body scan (WBS) followed by SPECT/CT was performed in all cases. Results In the 224 patients, 449 neck iodine avid foci were ascertained at SPECT/CT, while 322 were evidenced at WBS in 165/224 patients. WBS classified as residues 263/322 foci and as unclear 59/322 foci; among the former foci SPECT/CT correctly characterized 8 LN metastases and 3 physiologic uptakes and among the latter, it pinpointed 26 LN metastases, 18 residues, and 15 physiologic uptakes. SPECT/CT also classified 127 foci occult at WBS as 59 LN metastases and 68 residues. Globally, SPECT/CT identified 93 LN metastases in 59 patients (26 H, 20 L, 13 VL), while WBS evidenced 34 in 25 cases. All 13 VL patients, T1aN0M0, 5 of whom with LN near sub-mandibular glands, had thyroglobulin undetectable or < 2.5 ng/ml. Globally, SPECT/CT obtained an incremental value than WBS in 45.5% of patients, a more correct patient classification changing therapeutic approach in 30.3% of cases and identified WBS false-positive findings in 8% of cases. Conclusions 131I-SPECT/CT proved to correctly detect and characterize neck LN metastases in DTC patients in long-term follow-up, improving the performance of planar WBS. SPECT/CT routine use is thus suggested; its role is particularly relevant in patients with WBS inconclusive, VL, T1aN0M0 and with undetectable or very low thyroglobulin levels.
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Liu H, Chen Y, Liu L. Unusual uptake of 131iodine in bilateral ovarian endometriosis cysts in a patient with thyroid cancer. Endocrine 2019; 66:693-694. [PMID: 31502210 DOI: 10.1007/s12020-019-02079-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/29/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Huipan Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, PR China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, PR China.
| | - Lin Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, PR China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, PR China
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Malamitsi JV, Koutsikos JT, Giourgouli SI, Zachaki SF, Pipikos TA, Vlachou FJ, Prassopoulos VK. I-131 Postablation SPECT/CT Predicts Relapse of Papillary Thyroid Carcinoma more Accurately than Whole Body Scan. In Vivo 2019; 33:2255-2263. [PMID: 31662565 DOI: 10.21873/invivo.11731] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/25/2019] [Accepted: 07/31/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of the study was to prospectively compare I-131 postablation Whole Body scan (WBS) and Single Photon Emission Computerized Tomography/Computerized Tomography (SPECT/CT) scan on thyroid cancer patients. PATIENTS AND METHODS Overall, 58 patients with papillary thyroid carcinoma were submitted to total thyroidectomy and I-131 remnant ablation. Post-ablation WBS and SPECT/CT scans performed on the same day were compared. Results of SPECT/CT were confirmed by neck and upper mediastinum ultrasound scan and on specific cases by a fully diagnostic CT scan, other tests and definitive histology acting as the gold standard. A total of 36/58 patients were followed-up for 5 years to detect relapse. RESULTS Mac Nemar Chi square and Fisher's exact tests disclosed statistically significant differences between WBS and SPECT/CT scan, concerning cervical lymphadenopathy detection (p=0.031) and relapse prediction by NM stage (p=0.033), respectively; SPECT/CT was more accurate in both comparisons. CONCLUSION In papillary thyroid carcinoma I-131 post-ablation SPECT/CT scan detects cervical lymphadenopathy and predicts relapse by NM stage more accurately than WBS.
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Affiliation(s)
- Julia V Malamitsi
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - John T Koutsikos
- Department of Nuclear Medicine, Army Share Fund Hospital (417 NIMTS), Athens Greece and Department of Nuclear Medicine, Henry Dunant Hospital Centre, Athens, Greece
| | - Stamatia I Giourgouli
- Department of Medical Physics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia F Zachaki
- Laboratory of Health Physics, Radiobiology and Cytogenetics, National Centre for Scientific Research (NCSR) "Demokritos", Athens, Greece
| | | | - Fani J Vlachou
- Nuclear Medicine Department, Hygeia Hospital, Maroussi, Greece
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Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, Kuwert T, la Fougère C, Mariani G, Massalha S, Paez D, Giammarile F. Two decades of SPECT/CT - the coming of age of a technology: An updated review of literature evidence. Eur J Nucl Med Mol Imaging 2019; 46:1990-2012. [PMID: 31273437 PMCID: PMC6667427 DOI: 10.1007/s00259-019-04404-6] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality two decades ago. The main advantage of SPECT/CT is the increased specificity achieved through a more precise localization and characterization of functional findings. The improved diagnostic accuracy is also associated with greater diagnostic confidence and better inter-specialty communication. METHODS This review presents a critical assessment of the relevant literature published so far on the role of SPECT/CT in a variety of clinical conditions. It also includes an update on the established evidence demonstrating both the advantages and limitations of this modality. CONCLUSIONS For the majority of applications, SPECT/CT should be a routine imaging technique, fully integrated into the clinical decision-making process, including oncology, endocrinology, orthopaedics, paediatrics, and cardiology. Large-scale prospective studies are lacking, however, on the use of SPECT/CT in certain clinical domains such as neurology and lung disorders. The review also presents data on the complementary role of SPECT/CT with other imaging modalities and a comparative analysis, where available.
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Affiliation(s)
- Ora Israel
- Rappaport School of Medicine, Israel Institute of Technology, Haifa, Israel.
| | - O Pellet
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - L Biassoni
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D De Palma
- Nuclear Medicine Unit, Circolo Hospital, ASST-Settelaghi, Varese, Italy
| | - E Estrada-Lobato
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, University Hospital, Erlangen, Germany
| | - C la Fougère
- Division of Nuclear Medicine and Clinical Molecular Imaging, Department of Radiology, University Hospital, Tubingen, Germany
| | - G Mariani
- Regional Center of Nuclear Medicine, University of Pisa, Pisa, Italy
| | - S Massalha
- Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
- Department of Nuclear Medicine, Rambam Healthcare Campus, Haifa, Israel
| | - D Paez
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
| | - F Giammarile
- Nuclear Medicine and Diagnostic Imaging Section International Atomic Energy Agency, Vienna, Austria
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Karamzade-Ziarati N, Manafi-Farid R, Ataeinia B, Langsteger W, Pirich C, Mottaghy FM, Beheshti M. Molecular imaging of bone metastases using tumor-targeted tracers. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 63:136-149. [PMID: 31315347 DOI: 10.23736/s1824-4785.19.03206-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Bone metastasis is a disastrous manifestation of most malignancies, especially in breast, prostate and lung cancers. Since asymptomatic bone metastases are not uncommon, early detection, precise assessment, and localization of them are very important. Various imaging modalities have been employed in the setting of diagnosis of bone metastasis, from plain radiography and bone scintigraphy to SPECT, SPECT/CT, PET/CT, MRI. However, each modality showed its own limitation providing accurate diagnostic performance. In this regard, various tumor-targeted radiotracers have been introduced for molecular imaging of bone metastases using modern hybrid modalities. In this article we review the strength of different cancer-specific radiopharmaceuticals in the detection of bone metastases. As shown in the literature, among various tumor-targeted tracers, 68Ga DOTA-conjugated-peptides, 68Ga PSMA, 18F DOPA, 18F galacto-RGD integrin, 18F FDG, 11C/18F acetate, 11C/18F choline, 111In octreotide, 123/131I MIBG, 99mTc MIBI, and 201Tl have acceptable capabilities in detecting bone metastases depending on the cancer type. However, different study designs and gold standards among reviewed articles should be taken into consideration.
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Affiliation(s)
- Najme Karamzade-Ziarati
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahar Ataeinia
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Werner Langsteger
- PET-CT Center Linz, Department of Nuclear Medicine, Ordensklinikum, St. Vincent's Hospital, Linz, Austria
| | - Christian Pirich
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria
| | - Felix M Mottaghy
- Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany.,Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Mohsen Beheshti
- Department of Nuclear Medicine & Endocrinology, Paracelsus Medical University, Salzburg, Austria - .,Department of Nuclear Medicine, University Hospital, RWTH University, Aachen, Germany
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Van Nostrand D. Radioiodine Imaging for Differentiated Thyroid Cancer: Not All Radioiodine Images Are Performed Equally. Thyroid 2019; 29:901-909. [PMID: 31184275 DOI: 10.1089/thy.2018.0690] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Radioiodine scanning may help risk stratify patients with differentiated thyroid carcinoma (DTC) during initial and subsequent restaging. To maximize the information obtained from radioiodine scanning, image quality and interpretation should be optimized. However, not all radioiodine scans are performed equally. This illustrated article reviews seven techniques that may significantly improve the information obtained from a radioiodine scan in patients with DTC, which in turn may alter management such as showing regional or distant metastases that were otherwise unknown and/or help classify whether a metastasis is radioiodine avid. Summary: The first of the techniques is spot imaging of anatomical areas of interest using a gamma camera with a parallel-hole collimator. Spot images typically provide superior spatial resolution and enhanced lesion detection compared with whole-body scans using the same equipment. The second technique is spot imaging of the thyroid bed and neck with a pin-hole collimator, further improving spatial resolution. Two other techniques, delayed image acquisition and longer acquisition time, may clarify the nature of indeterminate foci of uptake or areas with negative initial findings. Delayed image acquisition may increase tumor-to-background ratio and thus improves lesion detectability. Longer acquisition times also increase contrast resolution between lesions and background activity, again increasing the detectability of malignant lesions. The fifth technique, adjustment of image brightness/contrast on film or on the computer screen, may reveal previously unobserved subtle differences in counts. The sixth technique, focus-specific history, comprises additional patient information that is specific to a focus of radioiodine uptake and elicited by the nuclear medicine physician or technologist. The goal is to help determine if the focus represents a metastasis or an artifact, which in turn decreases false positives and increases specificity. The seventh technique, single-photon emission computed tomography/computed tomography, improves contrast resolution and helps localize foci of uptake to anatomical structures. Conclusions: Technique is important to maximize information obtained from radioiodine scans in patients with DTC. With the greater usage and understanding of these seven techniques, physicians will significantly improve the information obtained from a radioiodine scan in patients with DTC, which in turn may alter management and potentially outcomes.
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Affiliation(s)
- Douglas Van Nostrand
- 1Nuclear Medicine Research, MedStar Health Research Institute, Washington, District of Columbia
- 2Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington, District of Columbia
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Santhanam P, Ladenson PW. Surveillance for Differentiated Thyroid Cancer Recurrence. Endocrinol Metab Clin North Am 2019; 48:239-252. [PMID: 30717906 DOI: 10.1016/j.ecl.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Serum thyroglobulin monitoring along with anatomic and functional imaging play key roles in the surveillance of patients with differentiated thyroid cancer after initial treatment. Among patients with a disease stage justifying thyroid remnant ablation or with suspected metastatic disease, radioiodine whole-body scans are essential in the months after surgery. For patients with low to moderate-risk cancers, ultrasonography of the neck (with measurement of serum thyroglobulin on thyroid hormone replacement) are the best initial diagnostic modalities, and are often the only tests required. In individuals suspected of having distant metastases, CT, MRI, and 18F-FDG PET can make important contributions in localizing residual disease and monitoring its progression and responses to therapy, provided they are used in the appropriate setting.
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Affiliation(s)
- Prasanna Santhanam
- Division of Endocrinology, Metabolism and Diabetes, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Suite 3 B 73, Baltimore, MD 21224, USA.
| | - Paul W Ladenson
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA
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15
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Kreissl MC, Grande E. Inconclusive Analysis of the Connection Between Secondary Hematologic Malignancies and Radioiodine Treatment. J Clin Oncol 2018; 36:1882-1883. [PMID: 29723089 DOI: 10.1200/jco.2018.78.1054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michael C Kreissl
- Michael C. Kreissl, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany; and Enrique Grande, MD Anderson Cancer Center, Madrid, Spain
| | - Enrique Grande
- Michael C. Kreissl, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany; and Enrique Grande, MD Anderson Cancer Center, Madrid, Spain
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16
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Ahmed N, Niyaz K, Borakati A, Marafi F, Birk R, Usmani S. Hybrid SPECT/CT Imaging in the Management of Differentiated
Thyroid Carcinoma. Asian Pac J Cancer Prev 2018; 19:303-308. [PMID: 29479949 PMCID: PMC5980912 DOI: 10.22034/apjcp.2018.19.2.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Differentiated thyroid cancer (DTC) has a good prognosis overall; however, lifelong follow-up is required for
many cases. Radioiodine planar imaging with iodine-123 (I-123) or radioiodine-131 (I-131) remains the standard in
the follow-up after initial surgery and ablation of residual thyroid tissue using I-131 therapy. Radioiodine imaging
is also used in risk-stratifying and for staging of thyroid cancer, and in long-term follow-up. Unfortunately, the lack
of anatomical detail on planar gamma camera imaging and superimposition of areas presenting with increased radioiodine
uptake can make accurate diagnosis and localization of radioiodine-avid metastatic disease challenging, leading to false
positive results and potentially to over-treatment of patients. Hybrid SPECT/CT allows precise anatomical localization
and superior characterization of foci of increased tracer uptake when compared to planar imaging. This, in turn, allows the
differentiation of pathological and physiological uptake, increasing the accuracy of image interpretation and ultimately
improving the accuracy of DTC staging and subsequent patient management. In this review, we look at the unique and
emerging role that SPECT/CT plays in the management of DTC, illustrated by examples from our own clinical practice.
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Affiliation(s)
- Najeeb Ahmed
- Department of Radiology and Nuclear Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, United Kingdom.
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Van Nostrand D. Selected Controversies of Radioiodine Imaging and Therapy in Differentiated Thyroid Cancer. Endocrinol Metab Clin North Am 2017; 46:783-793. [PMID: 28760238 DOI: 10.1016/j.ecl.2017.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This article discusses the more controversial areas of the management of differentiated thyroid cancer, namely, the utility of pretherapy staging radioiodine scans; the prescribed activity for iodine-131 remnant ablation, adjuvant treatment, and distant metastases; preparation with thyroid hormone withdrawal versus recombinant human thyroid-stimulating hormone; and the classification of radioiodine refractory differentiated thyroid cancer. The author reviews various aspects of the controversies, such as the recommendations of the 2015 guidelines of the American Thyroid Association, arguments for and against the various controversies, and selected references.
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Affiliation(s)
- Douglas Van Nostrand
- Nuclear Medicine Research, Division of Nuclear Medicine, MedStar Health Research Institute, MedStar Washington Hospital Center, Georgetown University School of Medicine, Suite GA60F, 110 Irving Street, Northwest, Washington, DC 20010, USA.
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18
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Szujo S, Sira L, Bajnok L, Bodis B, Gyory F, Nemes O, Rucz K, Kenyeres P, Valkusz Z, Sepp K, Schmidt E, Szabo Z, Szekeres S, Zambo K, Barna S, Nagy EV, Mezosi E. The impact of post-radioiodine therapy SPECT/CT on early risk stratification in differentiated thyroid cancer; a bi-institutional study. Oncotarget 2017; 8:79825-79834. [PMID: 29108364 PMCID: PMC5668097 DOI: 10.18632/oncotarget.19781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/18/2017] [Indexed: 11/25/2022] Open
Abstract
Objective SPECT/CT has numerous advantages over planar and traditional SPECT images. The aim of this study was to evaluate the role of post-radioiodine therapy SPECT/CT of patients with differentiated thyroid cancer (DTC) in early risk classification and in prediction of late prognosis. Patients and methods 323 consecutive patients were investigated after their first radioiodine treatment (1100–3700 MBq). Both whole body scan and SPECT/CT images of the head, neck, chest and abdomen regions were taken 4–6 days after radioiodine therapy. Patients were re-evaluated 9–12 months later as well as at the end of follow up (median 37 months). Results Post-radioiodine therapy SPECT/CT showed metastases in 22% of patients. Lymph node, lung and bone metastases were detected in 61, 13 and 5 patients, respectively, resulting in early reclassification of 115 cases (36%). No evidence of disease was found in 251 cases at 9–12 months after radioiodine treatment and 269 patients at the end of follow-up. To predict residual disease at the end of follow-up, the sensitivities, specificities and diagnostic accuracies of the current risk classification systems and SPECT/CT were: ATA: 77%, 47% and 53%; ETA: 70%, 62% and 64%; SPECT/CT: 61%, 88% and 83%, respectively. There was no difference between cohorts of the two institutions when data were analyzed separately. Conclusions Based on our bi-institutional experience, the accuracy of post-radioiodine SPECT/CT outweighs that of the currently used ATA and ETA risk classification systems in the prediction of long-term outcome of DTC.
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Affiliation(s)
- Szabina Szujo
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Livia Sira
- Department of Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Laszlo Bajnok
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Beata Bodis
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Ferenc Gyory
- Department of Surgery, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Orsolya Nemes
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Karoly Rucz
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Peter Kenyeres
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Zsuzsanna Valkusz
- Ist Department of Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Krisztian Sepp
- Ist Department of Medicine, University of Szeged, H-6720 Szeged, Hungary
| | - Erzsebet Schmidt
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Zsuszanna Szabo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Sarolta Szekeres
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Katalin Zambo
- Department of Nuclear Medicine, University of Pecs, H-7624 Pecs, Hungary
| | - Sandor Barna
- Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Endre V Nagy
- Department of Medicine, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary
| | - Emese Mezosi
- Ist Department of Medicine, University of Pecs, H-7624 Pecs, Hungary
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Zilioli V, Peli A, Panarotto MB, Magri G, Alkraisheh A, Wiefels C, Rodella C, Giubbini R. Differentiated thyroid carcinoma: Incremental diagnostic value of 131I SPECT/CT over planar whole body scan after radioiodine therapy. Endocrine 2017; 56:551-559. [PMID: 27709475 DOI: 10.1007/s12020-016-1086-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/10/2016] [Indexed: 12/13/2022]
Abstract
The purpose of this prospective study was to determine the incremental diagnostic value of single photon emission computed tomography/computed tomography with iodine-131 over planar whole body scan in the staging of patients with differentiated thyroid carcinoma. A total of 365 patients (270 female, 95 male) with differentiated thyroid carcinoma were treated with radioiodine therapy for thyroid remnant ablation with radical intent after thyroidectomy between January 2013 and November 2014. In addition to planar whole body scan, single photon emission computed tomography/computed tomography of neck and chest were performed. Each radioactive focus at whole body scan was classified as positive or equivocal with respect of specific territories: thyroid bed, cervical lymph nodes and distant metastases.Whole-body scan detected focal uptake in 353 patients and no uptake in 12. The location was considered equivocal in 100. Single photon emission computed tomography/computed tomography detected focal uptake in 356 patients and no uptake in nine. In three patients with negative wholebody scan, single photon emission computed tomography/computed tomography provided information about residual activity in the thyroid bed. By single photon emission computed tomography/computed tomography the location was equivocal in 18 patients only. Single photon emission computed tomography/computed tomography was helpful in 82 out of 100 patients with equivocal findings by whole body scan allowing a correct identification of the uptake sites. In a great number of equivocal whole body scan, due to high remnant activity, single photon emission computed tomography/computed tomography was able to differentiate between thyroid remnant and lymph nodes uptake. In 22 out of 100 patients with doubtful whole body scan, single photon emission computed tomography/computed tomography correctly identified nodal or distant metastases, and in 2/100 patients, focal uptake classified as metastatic by whole body scan was reclassified as para-physiological by single photon emission computed tomography/computed tomography. The TNM classification changed in 13 out of 22 patients. Single photon emission computed tomography/computed tomography improves detection and localization of the iodine-131 uptake after thyroidectomy in patients with differentiated thyroid carcinoma and it is more accurate than whole body scan to evaluate lymph nodes and to identify and characterize distant metastases. Single photon emission computed tomography/computed tomography aids assessment of lower/upper stage in a significant number of patients with differentiated thyroid carcinoma and it can affect therapy decision-making and patient management.
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MESH Headings
- Adenocarcinoma, Follicular/diagnostic imaging
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/radiotherapy
- Adenocarcinoma, Follicular/surgery
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/diagnostic imaging
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/radiotherapy
- Carcinoma, Papillary/surgery
- Carcinoma, Papillary, Follicular/diagnostic imaging
- Carcinoma, Papillary, Follicular/pathology
- Carcinoma, Papillary, Follicular/radiotherapy
- Carcinoma, Papillary, Follicular/surgery
- Female
- Humans
- Iodine Radioisotopes/therapeutic use
- Male
- Middle Aged
- Neoplasm Staging
- Radiotherapy Dosage
- Single Photon Emission Computed Tomography Computed Tomography/methods
- Thyroid Neoplasms/diagnostic imaging
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/radiotherapy
- Thyroid Neoplasms/surgery
- Thyroidectomy
- Whole Body Imaging/methods
- Young Adult
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Affiliation(s)
- Valentina Zilioli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Alessia Peli
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Maria Beatrice Panarotto
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Giancarlo Magri
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Ahmed Alkraisheh
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy
| | - Christiane Wiefels
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil
| | - Carlo Rodella
- Medical Physics Department, Spedali Civili di Brescia, Brescia, Italy
| | - Raffaele Giubbini
- Nuclear Medicine Unit, Department of Diagnostic Imaging, Spedali Civili and University of Brescia, Brescia, Italy.
- Chair of Nuclear Medicine, Federal Fluminense University, Rio de Janeiro, Brazil.
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20
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Kulkarni K, Khorjekar G, Mete M, Van Nostrand D. Number of Foci of Functioning Thyroid Tissue Remaining after Thyroidectomy for Differentiated Thyroid Cancer: Institutional Experience. World J Nucl Med 2017; 16:122-125. [PMID: 28553178 PMCID: PMC5436317 DOI: 10.4103/1450-1147.203066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Radioiodine imaging of the neck with a pinhole collimator (PinC) is frequently performed in differentiated thyroid cancer (DTC) patients for visualizing individual, and a total number of foci (NOF) of functioning residual thyroid tissue (FRTT) within the thyroid bed in postthyroidectomy patients. The objective of this study was to determine our experience regarding the NOF of FRTT visualized on pretherapy radioiodine PinC images. We performed a retrospective review of radioiodine PinC images of the neck of patients with very low-risk DTC and who had thyroidectomy performed by selected surgeons at MedStar Washington Hospital Center. For each patient's image, the NOF of FRTT was determined by two blind readers. Statistical analysis was performed. One hundred and twenty-six patients met the criteria. Surgeon (S1, S2, S3, and S4) performed 17, 10, 86, and 13 thyroidectomies, respectively. The analysis (mean, range, and standard deviation) of NOF of FRTT was: S1: (2.2, 0-5, 1.3); S2: (1.6, 1–3, 0.8); S3: (2.6, 0–7, 1.5); S4: (3.3, 1–5, 1.3). The percentages of < 2, ≤3, ≤4, and <5 foci remaining were 4.9%, 21.5%, 77.0%, and 91.3%, respectively. For the selected surgeons, the NOF of FRTT in the thyroid bed or neck in postthyroidectomy patients never exceeded 7, rarely exceeded 5 (2.4%), and infrequently exceeded 4 (8.7%). Based on these data, our thresholds of the NOF for which we perform further workup for possible locoregional disease are ≥5. Each facility is encouraged to establish their own criteria for their facility and preferably for each of their surgeons.
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Affiliation(s)
- Kanchan Kulkarni
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington DC, USA
| | - Gauri Khorjekar
- Department of Radiology, George Washington University Hospital, Washington DC, USA
| | - Mihriye Mete
- Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, Maryland, USA
| | - Douglas Van Nostrand
- Division of Nuclear Medicine, MedStar Washington Hospital Center, Washington DC, USA
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Lee SW. SPECT/CT in the Treatment of Differentiated Thyroid Cancer. Nucl Med Mol Imaging 2017; 51:297-303. [PMID: 29242723 DOI: 10.1007/s13139-017-0473-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/07/2016] [Accepted: 01/20/2017] [Indexed: 01/25/2023] Open
Abstract
Single-photon emission computed tomography with integrated computed tomography (SPECT/CT) systems has been applied in a wide range of clinical circumstances, and differentiated thyroid cancer (DTC) is one of the most important indications of SPECT/CT imaging. In the treatment of DTC, SPECT/CT images have been reported to have many advantages over conventional planar whole-body scintigraphy based on its precise localization and characterization of abnormal foci of radioactive iodine (RAI) accumulation, influencing the staging, risk stratification, and clinical management as well as reader confidence. On the other hand, SPECT/CT has limitations including additional radiation exposure from the CT component, additional imaging time, and cost-related issues. Each SPECT/CT image acquired at different time points throughout the management of DTC may have a different clinical meaning and significance. This review article addresses the clinical usefulness of RAI SPECT/CT images acquired during the pre-ablation period, post-therapy period, and long-term follow-up period, respectively.
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Affiliation(s)
- Sang-Woo Lee
- Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine, 807 Hoguk-ro, Buk-gu, Daegu, Republic of Korea 41404
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22
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Less is more: reconsidering the need for regular use of diagnostic whole body radioiodine scintigraphy in the follow-up of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2017; 44:741-743. [DOI: 10.1007/s00259-017-3632-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 01/01/2017] [Indexed: 01/08/2023]
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False Positive Findings on I-131 WBS and SPECT/CT in Patients with History of Thyroid Cancer: Case Series. Case Rep Endocrinol 2017; 2017:8568347. [PMID: 28246564 PMCID: PMC5299196 DOI: 10.1155/2017/8568347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/28/2016] [Indexed: 11/17/2022] Open
Abstract
Introduction. Although whole body scan (WBS) with I-131 is a highly sensitive tool for detecting normal thyroid tissue and metastasis of differentiated thyroid cancer (DTC), it is not specific. Additional information, provided by single photon emission computed tomography combined with X-ray computed tomography (SPECT/CT) and by the serum thyroglobulin level, is extremely useful for the interpretation of findings. Case Presentation. We report four cases of false positive WBS in patients with DTC: ovarian uptake corresponding to an endometrioma, scrotal uptake due to a spermatocele, rib-cage uptake due to an old fracture, and hepatic and renal uptake secondary to a granuloma and simple cyst, respectively. Conclusions. Trapping, organification, and storage of iodine are more prominent in thyroid tissue but not specific. Physiologic sodium-iodine symporter expression in other tissues explains some, but not all, of the WBS false positive cases. Other proposed etiologies are accumulation of radioiodine in inflamed organs, metabolism of radiodinated thyroid hormone, presence of radioiodine in body fluids, and contamination. In our cases nonthyroidal pathologies were suspected since the imaging findings were not corroborated by an elevated thyroglobulin level, which is considered a reliable tumor marker for most well-differentiated thyroid cancers. Clinicians should be aware of the potential pitfalls of WBS in DTC to avoid incorrect management.
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Elisei R, Agate L, Mazzarri S, Bottici V, Guidoccio F, Molinaro E, Boni G, Ferdeghini M, Mariani G. Radionuclide Therapy of Thyroid Tumors. NUCLEAR ONCOLOGY 2017:1197-1241. [DOI: 10.1007/978-3-319-26236-9_49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2025]
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Ilhan H, Mustafa M, Bartenstein P, Kuwert T, Schmidt D. Rate of elimination of radioiodine-avid lymph node metastases of differentiated thyroid carcinoma by postsurgical radioiodine ablation. A bicentric study. Nuklearmedizin 2016; 55:221-227. [PMID: 27588323 DOI: 10.3413/nukmed-0794-16-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 08/18/2016] [Indexed: 12/31/2022]
Abstract
SPECT/CT detects radioiodine-positive cervical lymph node metastases (LNMs) of differentiated thyroid carcinoma (DTC) at the time of postsurgical radioablation (RA). Preliminary evidence indicates that the majority of LNMs are successfully treated by RA. The aim of this study was to confirm this evidence in a bicentric setting and to evaluate whether size is a predictor for successful elimination. PATIENTS AND METHODS Since 01/2007 and 05/2008, respectively, SPECT/spiral-CT is performed routinely in all patients with DTC at RA in two University Clinics. The outcome of iodine-positive LNMs identified by SPECT/CT until 12/2012 was analyzed by follow-up diagnostic 131I scans and serum thyreoglobulin (Tg) values. LNM volume and short-axis diameter were evaluated as prognostic factors by a receiver-operating characteristic (ROC) analysis. RESULTS 79 patients with 97 iodine-positive LNMs were included. Surgery was carried out in 8 patients with 13 LNMs due to the presence of additional iodine-negative lesions. Of the remaining 84 LNMs, 74 (88%) were successfully treated as demonstrated by radioiodine scans at follow-up. 10 LNMs persisted. 67/70 LNMs smaller than 0.9 ml were treated successfully, whereas this was the case of only 6/14 exceeding this threshold. Using this cut-off level to predict treatment success, sensitivity, specificity, positive and negative predictive value were 92%, 73%, 96%, and 57%. Results for short-axis diameter (cut-off level < 1cm) were 90%, 69%, 94% and 56%. CONCLUSION RA is effective in the treatment of the majority of 131I-positive LNMs identified in SPECT/CT images. In this study, 88% of iodine-positive LNM in DTC were successfully treated by radioiodine given at RA. Both LNM volume and diameter are reliable predictors of treatment success.
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Affiliation(s)
- Harun Ilhan
- Harun Ilhan, M.D., Department of Nuclear Medicine, Klinikum Grosshadern, University of Munich, Marchioninistraße 15, 81377 München, Germany, E-Mail:
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Wong KK, Gandhi A, Viglianti BL, Fig LM, Rubello D, Gross MD. Endocrine radionuclide scintigraphy with fusion single photon emission computed tomography/computed tomography. World J Radiol 2016; 8:635-655. [PMID: 27358692 PMCID: PMC4919764 DOI: 10.4329/wjr.v8.i6.635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 11/09/2015] [Accepted: 03/18/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To review the benefits of single photon emission computed tomography (SPECT)/computed tomography (CT) hybrid imaging for diagnosis of various endocrine disorders.
METHODS: We performed MEDLINE and PubMed searches using the terms: “SPECT/CT”; “functional anatomic mapping”; “transmission emission tomography”; “parathyroid adenoma”; “thyroid cancer”; “neuroendocrine tumor”; “adrenal”; “pheochromocytoma”; “paraganglioma”; in order to identify relevant articles published in English during the years 2003 to 2015. Reference lists from the articles were reviewed to identify additional pertinent articles. Retrieved manuscripts (case reports, reviews, meta-analyses and abstracts) concerning the application of SPECT/CT to endocrine imaging were analyzed to provide a descriptive synthesis of the utility of this technology.
RESULTS: The emergence of hybrid SPECT/CT camera technology now allows simultaneous acquisition of combined multi-modality imaging, with seamless fusion of three-dimensional volume datasets. The usefulness of combining functional information to depict the bio-distribution of radiotracers that map cellular processes of the endocrine system and tumors of endocrine origin, with anatomy derived from CT, has improved the diagnostic capability of scintigraphy for a range of disorders of endocrine gland function. The literature describes benefits of SPECT/CT for 99mTc-sestamibi parathyroid scintigraphy and 99mTc-pertechnetate thyroid scintigraphy, 123I- or 131I-radioiodine for staging of differentiated thyroid carcinoma, 111In- and 99mTc- labeled somatostatin receptor analogues for detection of neuroendocrine tumors, 131I-norcholesterol (NP-59) scans for assessment of adrenal cortical hyperfunction, and 123I- or 131I-metaiodobenzylguanidine imaging for evaluation of pheochromocytoma and paraganglioma.
CONCLUSION: SPECT/CT exploits the synergism between the functional information from radiopharmaceutical imaging and anatomy from CT, translating to improved diagnostic accuracy and meaningful impact on patient care.
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27
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 9488] [Impact Index Per Article: 1054.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Rosario PW, Mourão GF, Siman TL, Calsolari MR. A low postoperative nonstimulated serum thyroglobulin level excludes the presence of persistent disease in low-risk papillary thyroid cancer patients: implication for radioiodine indication. Clin Endocrinol (Oxf) 2015; 83:957-61. [PMID: 25393656 DOI: 10.1111/cen.12668] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/30/2014] [Accepted: 11/08/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the presence of persistent disease, including on post-therapy whole-body scan (RxWBS), in low-risk patients with papillary thyroid carcinoma (PTC) >1 cm who have low nonstimulated thyroglobulin (Tg) (measured with a sensitive assay), negative anti-Tg antibodies (TgAb) and neck ultrasound (US) showing no metastases after total thyroidectomy. PATIENTS We studied 154 patients with PTC >1 cm classified as low risk, who had US without metastases, negative TgAb, nonstimulated Tg ≤ 0·25 ng/ml and TSH ≤ 2 mIU/l about 3 months after total thyroidectomy. RESULTS Tg measured immediately before (131) I was ≤ 1 ng/ml in 89·5% of the patients and >1 ng/ml in 10·5%. None of the patients showed ectopic uptake on RxWBS. Uptake in the thyroid bed was observed in 146 (94·8%) patients and was ≤ 2% in all of them. In the control assessment 9-12 months after ablation, stimulated Tg (sTg) ≤ 1 ng/ml was achieved in 150 patients (97·4%). Only one patient had sTg >2 ng/ml (2·5 ng/ml) and none of the patients had apparent disease detected by imaging methods. During further short-term follow-up after control assessment (median of 24 months), none of the patients had tumour recurrence. CONCLUSIONS The combination of nonstimulated Tg ≤0·25 ng/ml, negative TgAb and US without metastases after thyroidectomy rules out the presence of persistent disease (including on RxWBS) in low-risk patients with PTC >1 cm. This demonstration weakens the indication of ablation with (131) I in these cases.
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Affiliation(s)
- Pedro W Rosario
- Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
- Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
| | - Gabriela F Mourão
- Postgraduate Program, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
- Endocrinology Service, Santa Casa de Belo Horizonte, Minas Gerais, Brazil
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Agrawal K, Bhattacharya A, Mittal BR. Role of single photon emission computed tomography/computed tomography in diagnostic iodine-131 scintigraphy before initial radioiodine ablation in differentiated thyroid cancer. Indian J Nucl Med 2015; 30:221-6. [PMID: 26170564 PMCID: PMC4479910 DOI: 10.4103/0972-3919.151650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives: The study was performed to evaluate the incremental value of single photon emission computed tomography/computed tomography (SPECT/CT) over planar radioiodine imaging before radioiodine ablation in the staging, management and stratification of risk of recurrence (ROR) in differentiated thyroid cancer (DTC) patients. Materials and Methods: Totally, 83 patients (21 male, 62 female) aged 17–75 (mean 39.9) years with DTC were included consecutively in this prospective study. They underwent postthyroidectomy planar and SPECT/CT scans after oral administration of 37–114 MBq iodine-131 (I-131). The scans were interpreted as positive, negative or suspicious for tracer uptake in the thyroid bed, cervical lymph nodes and sites outside the neck. In each case, the findings on planar images were recorded first, without knowledge of SPECT/CT findings. Operative and pathological findings were used for postsurgical tumor–node–metastasis staging. The tumor staging was reassessed after each of these two scans. Results: Single photon emission computed tomography/computed tomography localized radioiodine uptake in the thyroid bed in 9/83 (10.8%) patients, neck nodes in 24/83 (28.9%) patients and distant metastases in 8/83 (9.6%) patients in addition to the planar study. Staging was changed in 8/83 (9.6%), ROR in 11/83 (13.2%) and management in 26/83 (31.3%) patients by the pretherapy SPECT/CT in comparison to planar imaging. SPECT/CT had incremental value in 32/83 patients (38.5%) over the planar scan. Conclusion: Single photon emission computed tomography/computed tomography is feasible during a diagnostic I-131 scan with a low amount of radiotracer. It improved the interpretation of pretherapy I-131 scintigraphy and changed the staging and subsequent patient management.
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Affiliation(s)
- Kanhaiyalal Agrawal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wong KK, Fig LM, Youssef E, Ferretti A, Rubello D, Gross MD. Endocrine scintigraphy with hybrid SPECT/CT. Endocr Rev 2014; 35:717-46. [PMID: 24977318 DOI: 10.1210/er.2013-1030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Nuclear medicine imaging of endocrine disorders takes advantage of unique cellular properties of endocrine organs and tissues that can be depicted by targeted radiopharmaceuticals. Detailed functional maps of biodistributions of radiopharmaceutical uptake can be displayed in three-dimensional tomographic formats, using single photon emission computed tomography (CT) that can now be directly combined with simultaneously acquired cross-sectional anatomic maps derived from CT. The integration of function depicted by scintigraphy and anatomy with CT has synergistically improved the efficacy of nuclear medicine imaging across a broad spectrum of clinical applications, which include some of the oldest imaging studies of endocrine dysfunction.
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Affiliation(s)
- Ka Kit Wong
- Nuclear Medicine/Radiology Department (K.K.W., E.Y., M.D.G.), University of Michigan Hospital, Ann Arbor, Michigan 48109; Nuclear Medicine Service (K.K.W., L.M.F., M.D.G.), Department of Veterans Affairs Health System, Ann Arbor, Michigan 48105; and Department of Nuclear Medicine (A.F., D.R.), Radiology, Medical Physics, Santa Maria della Misericordia Hospital, 45100 Rovigo, Italy
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Jeong SY, Lee SW, Kim HW, Song BI, Ahn BC, Lee J. Clinical applications of SPECT/CT after first I-131 ablation in patients with differentiated thyroid cancer. Clin Endocrinol (Oxf) 2014; 81:445-51. [PMID: 24716874 DOI: 10.1111/cen.12460] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/06/2014] [Accepted: 03/23/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to determine which thyroid cancer patients would benefit from SPECT/CT in addition to whole-body planar scintigraphy (RxWBS) for the detection and characterization of I-131 focal uptake after first ablation. DESIGN AND PATIENTS Neck and thoracic SPECT/CT was performed in 187 patients with I-131 focal uptake suggestive of remnant thyroid tissue (Rem group, n = 152) or presumed lymph node (LN) metastases (mLN group, n = 35) on RxWBS. Clinical and pathologic parameters were analysed and compared in patients with and without additional SPECT/CT findings. RESULTS wIn the Rem group, SPECT/CT revealed additional occult findings on RxWBS in 13 patients (8·6%). The serum thyroglobulin levels at the time of ablation were significantly higher in patients with additional SPECT/CT findings than in patients without additional findings (4·3 ± 3·4 ng/ml vs 1·6 ± 2·7 ng/ml, P = 0·001). In the mLN group, SPECT/CT demonstrated only remnant thyroid tissues without evidence of lymph node metastasis in 14 (40·0%) patients, whereas in the remaining 21 (60·0%) patients, I-131 uptake was confirmed in the corresponding neck and mediastinal lymph nodes on SPECT/CT. CONCLUSIONS Even in the Rem group, additional SPECT/CT could provide useful information for detecting hidden metastasis, especially in patients with high serum thyroglobulin levels. SPECT/CT should be recommended for patients with focal uptake lymph node metastasis on RxWBS.
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Affiliation(s)
- Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University Medical Center and School of Medicine, Daegu, Korea
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Barber TW, Cherk MH, Topliss DJ, Serpell JW, Yap KSK, Bailey M, Kalff V. The prevalence of thyroglossal tract thyroid tissue on SPECT/CT following (131) I ablation therapy after total thyroidectomy for thyroid cancer. Clin Endocrinol (Oxf) 2014; 81:266-70. [PMID: 24483626 DOI: 10.1111/cen.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/27/2013] [Accepted: 01/26/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence of thyroglossal tract thyroid tissue on SPECT/CT and to assess the contribution of this tissue to total neck radioactive iodine (RAI) activity in patients given (131) I ablation therapy after total thyroidectomy for thyroid cancer. PATIENTS AND METHODS Eighty-three consecutive patients with thyroid cancer treated with total thyroidectomy underwent whole-body planar and SPECT/CT imaging of the neck following initial RAI ablation. On SPECT/CT, thyroglossal tract thyroid tissue was defined as RAI in the anterior neck, superior to the thyroid bed in close proximity to the midline without evidence of localization to lymph nodes. Quantification was performed using region of interest analysis on planar imaging following localization on SPECT/CT. SPECT/CT, and planar images were classified by two reviewers as positive, negative or equivocal with interobserver agreement quantified using a Kappa score. Disagreement was resolved using a third reviewer. RESULTS Thyroglossal tract thyroid tissue was present in 39/83 (47%; 95%CI: 36-58%) patients on SPECT/CT. In these 39 patients, this tissue contributed to a significant amount of total neck activity (median = 50%; IQR 19-74%). Interobserver agreement for the presence of thyroglossal tract thyroid tissue was substantial on SPECT/CT (Kappa = 0.73) and fair on planar imaging (Kappa = 0.31). CONCLUSION Thyroglossal tract thyroid tissue was present in one half of our study population and contributed to a significant amount of total neck RAI activity. Given the high prevalence of this tissue, our results suggest that total neck RAI activity on planar imaging may not be suitable to assess the completeness of thyroid bed surgery.
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Affiliation(s)
- Thomas W Barber
- Department of Nuclear Medicine and PET Centre, Melbourne, Vic., Australia
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Perros P, Boelaert K, Colley S, Evans C, Evans RM, Gerrard Ba G, Gilbert J, Harrison B, Johnson SJ, Giles TE, Moss L, Lewington V, Newbold K, Taylor J, Thakker RV, Watkinson J, Williams GR. Guidelines for the management of thyroid cancer. Clin Endocrinol (Oxf) 2014; 81 Suppl 1:1-122. [PMID: 24989897 DOI: 10.1111/cen.12515] [Citation(s) in RCA: 770] [Impact Index Per Article: 70.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Petros Perros
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne
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Rosario PW, Mourão GF, dos Santos JBN, Calsolari MR. Is empirical radioactive iodine therapy still a valid approach to patients with thyroid cancer and elevated thyroglobulin? Thyroid 2014; 24:533-6. [PMID: 24067080 DOI: 10.1089/thy.2013.0427] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND At present, empirical radioactive iodine therapy is recommended for patients with thyroid cancer and elevated thyroglobulin (Tg) after initial therapy when neck ultrasonography (US), chest computed tomography (CT), and 18-fluorodeoxyglucose positron emission tomography (FDG-PET) do not reveal metastases. The objective of this study was to determine whether empirical (131)I therapy is indeed useful in these patients. METHODS Patients with papillary thyroid cancer submitted to total thyroidectomy followed by remnant ablation with (131)I in whom whole-body scanning at the time of ablation (WBS-ablation) did not reveal metastases and who had elevated Tg after initial therapy were selected. Included in the study were patients with basal Tg >2 ng/mL or Tg >5 ng/mL after stimulation with recombinant human thyrotropin or Tg >10 ng/mL after levothyroxine withdrawal for 4 weeks. All patients were first investigated by neck US and chest CT. FDG-PET/CT was performed in patients with negative US and CT. The final sample of this study consisted of patients with negative US, CT, and FDG-PET/CT. These patients received an activity of 100 mCi (131)I and were submitted to posttherapy WBS (RxWBS). RESULTS Among the 24 patients receiving empirical (131)I therapy, no ectopic uptake was seen in 23 and mild uptake in the thyroid bed (<0.5%) in 15. Only one patient presented pulmonary metastases detected by RxWBS. Disease was observed in two other patients during short-term follow-up (mean 22 months), one with lymph node metastases diagnosed by a repeat US and one with bone metastases diagnosed by CT and FDG-PET scans. CONCLUSIONS We conclude that RxWBS rarely reveals disease in patients with elevated Tg after ablation, but with negative findings on WBS-ablation, US, CT, and FDG-PET. In this situation, empirical (131)I therapy should be restricted to patients with documented progression of serum Tg.
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Glazer DI, Brown RKJ, Wong KK, Savas H, Gross MD, Avram AM. SPECT/CT evaluation of unusual physiologic radioiodine biodistributions: pearls and pitfalls in image interpretation. Radiographics 2013; 33:397-418. [PMID: 23479704 DOI: 10.1148/rg.332125051] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Radioiodine imaging has a well-established role in depicting metastatic disease after thyroidectomy in patients with well-differentiated thyroid cancer. Uptake of radioiodine in thyroid metastases depends on expression of sodium-iodide symporter (NIS) by tumor tissues. However, because radioiodine may also accumulate in normal structures and tissues, it is important to distinguish physiologic radioiodine activity from metastatic disease. Furthermore, secretions that contain radioiodine may also simulate pathologic uptake. A spectrum of physiologic distributions, normal variants, and benign mimics of disease have been described in the literature; yet, even when armed with a comprehensive knowledge of these patterns, interpreting radiologists and nuclear physicians may still encounter diagnostic uncertainty. Single-photon emission computed tomography (SPECT) with integrated computed tomography (CT) is a novel technology that, when applied to diagnostic iodine 123 or iodine 131 ((131)I) radioiodine scintigraphy, may accurately localize and help distinguish benign mimics of disease, with the potential to alter the management plan. SPECT/CT is increasingly being used with radioiodine scintigraphy to evaluate patients with thyroid cancer and shows promise for improving imaging specificity and reducing false-positive results.
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Affiliation(s)
- Daniel I Glazer
- Department of Nuclear Medicine/Radiology, University of Michigan Health System, 1500 E Medical Center Dr, B1 G505, Ann Arbor, MI 48109-5030, USA
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SPECT/CT and tumour imaging. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S67-80. [PMID: 23990144 DOI: 10.1007/s00259-013-2534-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 07/31/2013] [Indexed: 02/05/2023]
Abstract
Scintigraphic techniques are sensitive imaging modalities in the diagnosis and follow-up of cancer patients providing the functional and metabolic activity characteristics of the tumour. Hybrid SPECT/CT improves the diagnostic accuracy of these well-established imaging techniques by precise anatomical localization and characterization of morphological findings, differentiation between foci of physiological and pathological tracer uptake, resulting in a significant impact on patient management and more definitive interpretations. The use of SPECT/CT has been studied in a variety of applications in tumour imaging which are reviewed in this article. By combining functional and anatomical information in a single imaging session, SPECT/CT has become a one-stop cancer imaging modality.
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Comparison of the diagnostic and prognostic values of 99mTc-MDP-planar bone scintigraphy, 131I-SPECT/CT and 18F-FDG-PET/CT for the detection of bone metastases from differentiated thyroid cancer. Nucl Med Commun 2013; 33:1232-42. [PMID: 23111353 DOI: 10.1097/mnm.0b013e328358d9c0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The aim of this study was to compare the diagnostic and prognostic values of (99m)Tc-MDP-planar bone scintigraphy ((99m)Tc-MDP-BS), (131)I single-photon emission computed tomography/computed tomography ((131)I-SPECT/CT) and (18)F-fluorodeoxyglucose ((18)F-FDG)-PET/CT for the detection of bone metastases from differentiated thyroid cancer (DTC). METHODS Eighty patients with DTC with suspected bone metastases from DTC were retrospectively analysed. All patients were examined with (99m)(99m)Tc-MDP-BS, (131)I-SPECT/CT and (18)F-FDG-PET/CT, with a maximum interval of 2 months between scans. The diagnostic performances of (99m)Tc-MDP-BS, (131)I-SPECT/CT and (99m)F-FDG-PET/CT were investigated and compared. Univariate and multivariate analyses were carried out to evaluate the effects of variables on the survival of patients. RESULTS Out of the 80 patients with 148 foci, 43 with 106 foci were diagnosed as being true positive for bone metastases from DTC. In patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of (99m)Tc-MDP-BS were 79.07, 83.78, 85.00, 77.50 and 81.25%, respectively; those of (131)I-SPECT/CT were 93.02, 97.30, 97.56, 92.31 and 95.00%, and those of (18)F-FDG-PET/CT were 86.05, 94.59, 94.87, 85.36 and 87.80%, respectively. In lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of (99m)Tc-MDP-BS were 72.64, 73.81, 87.50, 51.67 and 72.97%, respectively; those of (131)I-SPECT/CT were 92.45, 97.62, 98.99, 83.67 and 93.92%, and those of (18)F-FDG-PET/CT were 85.85, 88.10, 94.50, 71.15 and 86.49%, respectively. Comparing the receiver-operating characteristic area using the McNemar test, both (131)I-SPECT/CT and (18)F-FDG-PET/CT were found to be superior to (99m)Tc-MDP-BS for the detection of bone metastases from DTC in patient-based and lesion-based analyses (P<0.05). Patient-based analysis showed that there were no significant differences between (131)I-SPECT/CT and (18)F-FDG-PET/CT (P=0.087) but lesion-based analysis revealed that (131)I-SPECT/CT was superior to (18)F-FDG-PET/CT (P=0.002). For the association between these image patterns and the prognosis of DTC patients, (18)F-FDG positivity was the factor predicting a poor prognosis. CONCLUSION (131)I-SPECT/CT and (18)F-FDG-PET/CT demonstrated high diagnostic performance in detecting bone metastases from DTC. (99m)Tc-MDP-BS might be completely replaced by (131)I-SPECT/CT in combination with ((131)F-FDG-PET/CT in the management of DTC patients with bone metastases. (18)F-FDG-PET/CT positivity was an independent factor associated with poor prognosis.
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Buton L, Morel O, Gault P, Illouz F, Rodien P, Rohmer V. False-positive Iodine-131 whole-body scan findings in patients with differentiated thyroid carcinoma: Report of 11 cases and review of the literature. ANNALES D'ENDOCRINOLOGIE 2013; 74:221-30. [DOI: 10.1016/j.ando.2013.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 11/17/2022]
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131I SPECT/CT: a one-station imaging modality in the management of differentiated thyroid cancer. Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bural GG, Muthukrishnan A, Oborski MJ, Mountz JM. Improved Benefit of SPECT/CT Compared to SPECT Alone for the Accurate Localization of Endocrine and Neuroendocrine Tumors. Mol Imaging Radionucl Ther 2012; 21:91-6. [PMID: 23487541 PMCID: PMC3590979 DOI: 10.4274/mirt.80299] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 11/19/2012] [Indexed: 01/16/2023] Open
Abstract
Objective: To assess the clinical utility of SPECT/ CT in subjects with endocrine and neuroendocrine tumors compared to SPECT alone. Material and Methods: 48 subjects (31 women;17 men; mean age 54±11) with clinical suspicion or diagnosis of endocrine and neuroendocrine tumor had 50 SPECT/CT scans (32 Tc-99m MIBI, 5 post treatment I-131, 8 In-111 Pentetreotide, and 5 I-123 MIBG). SPECT alone findings were compared to SPECT/CT and to pathology or radiological follow up. Results: From the 32 Tc-99m MIBI scans, SPECT accurately localized the lesion in 22 positive subjects while SPECT/CT did in 31 subjects. Parathyroid lesions not seen on SPECT alone were smaller than 10 mm. In five post treatment I-131 scans, SPECT alone neither characterized, nor localized any lesions accurately. SPECT/CT revealed 3 benign etiologies, a metastatic lymph node, and one equivocal lesion. In 8 In-111 Pentetreotide scans, SPECT alone could not localize primary or metastatic lesions in 6 subjects all of which were localized with SPECT/CT. In five I-123 MIBG scans, SPECT alone could not detect a 1.1 cm adrenal lesion or correctly characterize normal physiologic adrenal uptake in consecutive scans of the same patient with prior history of adrenelectomy, all of which were correctly localized and characterized with SPECT/CT. Conclusion: SPECT/CT is superior to SPECT alone in the assessment of endocrine and neuroendocrine tumors. It is better in lesion localization and lesion characterization leading to a decrease in the number of equivocal findings. SPECT/CT should be included in the clinical work up of all patients with diagnosis or suspicion of endocrine and neuroendocrine tumors. Conflict of interest:None declared.
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Affiliation(s)
- Gonca G Bural
- University of Pittsburgh Medical Center, Department of Radiology, Pittsburgh, PA, USA
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Xue YL, Qiu ZL, Song HJ, Luo QY. Value of ¹³¹I SPECT/CT for the evaluation of differentiated thyroid cancer: a systematic review of the literature. Eur J Nucl Med Mol Imaging 2012; 40:768-78. [PMID: 23242250 DOI: 10.1007/s00259-012-2310-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 11/19/2012] [Indexed: 12/12/2022]
Abstract
PURPOSE In the present study, we performed a systematic review of the current literature to assess the incremental value of (131)I single photon emission computed tomography (SPECT)/CT for the management of patients with differentiated thyroid cancer (DTC). METHODS The search of PubMed/MEDLINE and EMBASE databases to identify studies and reference lists for articles was conducted using the terms "SPECT or SPECT/CT or SPECT-CT or single photon emission computed tomography/computed tomography and thyroid carcinoma or thyroid cancer." Studies reporting the clinical value of (131)I SPECT/CT were selected. All studies included were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2). Two independent reviewers selected the studies, summarized and tabulated the data, and pooled estimates were obtained. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS A total of 14 studies involving 1,066 patients met the inclusion criteria. Data obtained included the impact of (131)I SPECT/CT on staging or risk classification (three studies), diagnostic accuracy (six studies), and follow-up (five studies). CONCLUSION Integrated SPECT/CT is a useful tool for the diagnosis, staging, risk stratification, and follow-up of DTC. The impact of (131)I SPECT/CT on the management of patients with thyroid cancer was evaluated.
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Affiliation(s)
- Yan-Li Xue
- Department of Nuclear Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Rd., Shanghai 200233, China
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Abstract
Radioiodine scintigraphy and therapy has played a major role in the treatment and follow-up of thyroid cancer patients for decades. Single-photon emission computed tomography/computed tomography in this setting is emerging as a useful tool in accurately localizing sites of pathological uptake and physiological mimics of disease, thus providing more accurate staging prognostic information for risk stratification, which in turn tailors management and follow-up regimes. This review presents the current evidence and potential indications of single-photon emission computed tomography/computed tomography in thyroid cancer.
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Maruoka Y, Abe K, Baba S, Isoda T, Sawamoto H, Tanabe Y, Sasaki M, Honda H. Incremental diagnostic value of SPECT/CT with 131I scintigraphy after radioiodine therapy in patients with well-differentiated thyroid carcinoma. Radiology 2012; 265:902-9. [PMID: 23012466 DOI: 10.1148/radiol.12112108] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To retrospectively determine the incremental diagnostic value of adding single photon emission computed tomography/computed tomography (SPECT/CT) to whole-body scintigraphy with iodine 131 ((131)I) compared with scintigraphy alone after radioiodine therapy in patients with well-differentiated thyroid carcinoma. MATERIALS AND METHODS This retrospective study was institutional review board approved; written informed consent was waived. The study included 147 patients (94 female, 53 male patients; mean age, 51 years) with well-differentiated thyroid carcinoma treated with radioiodine therapy between October 2009 and August 2010. Whole-body scintigraphy and SPECT/CT were performed on the same day in all patients receiving radioiodine therapy. Each radioactive focus at whole-body scintigraphy was classified as positive or equivocal with respect to thyroid bed, lymph node, and distant metastasis uptake. Differences between whole-body scintigraphy and SPECT/CT findings were assessed with the generalized McNemar test. RESULTS At SPECT/CT, origin was clearly determined of all five "hot spots" in the thyroid bed (remnant thyroid tissue or metastatic lymph node) that were judged as equivocal at whole-body scintigraphy. Interpretation of 24 (22.2%) of 108 radioactive foci for lymph node metastases was changed with SPECT/CT (P < .0001). One of 85 foci that were thought to be positive findings at whole-body scintigraphy turned out to be a negative finding (false-positive finding), and 13 and seven of 20 equivocal foci at whole-body scintigraphy were positive and negative findings, respectively, after adding SPECT/CT findings. Three false-negative findings at whole-body scintigraphy were corrected with SPECT/CT. For the detection of distant metastasis, the interpretations of 21 (40%) of 52 foci were corrected with SPECT/CT (P < .0001). One of 32 foci thought to be a positive finding at whole-body scintigraphy was a negative finding, and 11 and nine of 20 equivocal foci at whole-body scintigraphy were positive and negative findings, respectively, after SPECT/CT. At a patient-based analysis, SPECT/CT findings helped change the clinical staging in nine (6.1%) of 147 patients and therapeutic planning in three (2.0%) of 147 patients. CONCLUSION SPECT/CT improved detection and localization of (131)I accumulation in lymph node metastases and distant metastases, compared with whole-body scintigraphy.
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Affiliation(s)
- Yasuhiro Maruoka
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka City, Fukuoka 812-8582, Japan
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Guerrier B, Berthet JP, Cartier C, Dehesdin D, Edet-Sanson A, Le Clech G, Garrel R, Kania R, Makeieff M, Page C, Poirée S, Potard G, Prades JM, Righini C, Roussel F, Toubert ME. French ENT Society (SFORL) practice guidelines for lymph-node management in adult differentiated thyroid carcinoma. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129:197-206. [PMID: 22883640 DOI: 10.1016/j.anorl.2012.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- B Guerrier
- ENT & Head Neck Surgery Department, University Hospital Center of Montpellier, 191 avenue du Doyen-Gaston-Giraud, Montpellier cedex, France
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The role of nuclear medicine in differentiated thyroid cancer. Wien Med Wochenschr 2012; 162:407-15. [PMID: 22815124 DOI: 10.1007/s10354-012-0129-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
In differentiated thyroid cancer (DTC) nuclear medicine is able to cover the spectrum from diagnosis and treatment to follow up keeping patient's management in one institution. Nowadays, DTC is often diagnosed per chance, presenting as small indolent nodule diagnosed on routinely performed ultrasound. Ultrasound and ultrasonography-guided fine-needle aspiration biopsy together with scintigraphy are probably the most adequate tools for diagnosis. After thyroidectomy, treatment with iodine-131 is routinely performed in a nuclear medicine therapy institution as a standard procedure in most of the cases with regard to histology. In case of iodine positive metastases, repeated therapies can be performed in order to reduce tumour burden. In the follow up of DTC thyroglobulin (tumour marker), ultrasound and diagnostic whole body scan are established procedures. With the development of SPECT/CT and PET/CT ((18)F-FDG, (68)Ga-somatostatin receptor) combining functional and anatomic imaging the nuclear medicine spectrum has further increased.
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Silberstein EB, Alavi A, Balon HR, Clarke SE, Divgi C, Gelfand MJ, Goldsmith SJ, Jadvar H, Marcus CS, Martin WH, Parker JA, Royal HD, Sarkar SD, Stabin M, Waxman AD. The SNMMI Practice Guideline for Therapy of Thyroid Disease with 131I 3.0. J Nucl Med 2012; 53:1633-51. [DOI: 10.2967/jnumed.112.105148] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Avram AM. Radioiodine scintigraphy with SPECT/CT: an important diagnostic tool for thyroid cancer staging and risk stratification. J Nucl Med 2012; 42:170-80. [PMID: 22550280 DOI: 10.2967/jnumed.111.104133] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Staging and risk stratification predicate the postoperative management of thyroid cancer patients, determining not only the need for (131)I therapy or alternative options (conservative management without ablation, surgical reintervention, or external-beam radiation therapy) but also the long-term follow-up strategy. This paper presents the progress made in the field of thyroid cancer imaging by application of SPECT/CT technology to radioiodine scintigraphy in both diagnostic and post-therapy settings and reviews the impact of fusion radioiodine imaging on staging, risk stratification, and clinical management of patients with thyroid cancer. In addition, this paper addresses the role of preablation radioiodine imaging and provides nuclear medicine physicians with the background knowledge required for integrating information from fusion imaging into the clinical and histopathologic risk stratification for developing an individualized treatment plan for patients with thyroid cancer.
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Affiliation(s)
- Anca M Avram
- Division of Nuclear Medicine/Radiology, University of Michigan Medical Center, Ann Arbor, Michigan 48109-5028, USA.
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Blum M, Tiu S, Chu M, Goel S, Friedman K. I-131 SPECT/CT elucidates cryptic findings on planar whole-body scans and can reduce needless therapy with I-131 in post-thyroidectomy thyroid cancer patients. Thyroid 2011; 21:1235-47. [PMID: 22007920 DOI: 10.1089/thy.2011.0010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Interpreting I-131 whole-body scans (WBSs) after thyroidectomy for thyroid cancer is not simple. There are scans in which interpretation is speculative because of cryptic findings (CF). Complexity is added in scans that are done a week after an ablative or therapeutic dose of I-131 because not only is I-131-labeled thyroxine (T4) distributed throughout the body, but inorganic I-131 that is derived from the de-iodination of T4 may be also detected. We present our observations regarding the analysis of CF on WBS using I-131 single-photon emission computed tomography (SPECT) in fusion with noncontrast computed tomography (CT), referred to here and elsewhere as I-131 SPECT/CT. METHODS Forty of 184 WBSs in 38 thyroidectomized thyroid cancer patients were followed up with I-131 SPECT/CTs. The SPECT/CT images were acquired after a tracer dose of I-131 (n=82) or a week after an ablative or therapeutic dose of I-131 (n=102). RESULTS Among 184 WBSs, 40 (22%) had CF. In 35 patients the WBS was negative for metastatic disease except for the CF and 5 patients had evidence of thyroid cancer in addition to the CF. There were 49 CF in the planar scans that were localized by SPECT/CT. These were characterized as physiological uptake in gingiva, thymus, gall bladder, menstrual blood, uterine fibroid, recto-sigmoid, colon, and bladder. Also observed was uptake in sites that represented nonthyroidal pathology including dental abscess, hiatal hernia, renal cyst, and struma ovarii. SPECT/CT suggested that 10 of the CF were actually of thyroid origin. In 40 SPECT/CT scans, the images contributed to interpreting the scan. In 15 of 40 patients the SPECT/CT analysis of WBS was performed with tracer doses of I-131 and was important for determining whether to administer ablative I-131 treatment. In another 25 patients, in whom SPECT/CT was performed after ablative or therapeutic doses of 131-I, information regarding the characterization of CF by SPECT/CT was useful in determining if thyroid cancer metastases or thyroid remnants were present. CONCLUSIONS I-131 SPECT/CT is a useful tool to characterize atypical or CF on WBS by differentiating thyroid remnant or cancer from physiologic activity or nonthyroid pathology. In the past, uptake on a WBS that was not explicable as physiologic activity was identified as putative or possible thyroid cancer and generally was treated with I-131. Now, by identifying activity in some possible cancer sites as not thyroid cancer, SPECT/CT can reduce inappropriate treatment with I-131. SPECT/CT of WBS performed after ablative doses of 131-I is useful in determining the nature of CF and therefore likely providing prognostic information.
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Affiliation(s)
- Manfred Blum
- Division of Endocrinology, Department of Medicine, NYU Langone Medical Center, New York, New York 10016, USA
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