Positron emission tomography tracers in medullary thyroid carcinoma: Current evidence and emerging targets

doi:10.4329/wjr.v18.i5.120146

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Radiol. May 28, 2026; 18(5): 120146
Published online May 28, 2026. doi: 10.4329/wjr.v18.i5.120146

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Figure 1 The “flip-flop” phenomenon in medullary thyroid carcinoma imaging. As tumours dedifferentiate along the spectrum from well-differentiated (left) to poorly-differentiated (right), ¹⁸F-fluorodihydroxyphenylalanine uptake (blue curve) progressively decreases while ¹⁸F-fluorodeoxyglucose uptake (orange curve) reciprocally increases. The crossover point represents the transition where fluorodeoxyglucose becomes more informative than fluorodihydroxyphenylalanine. MTC: Medullary thyroid carcinoma; PET: Positron emission tomography; ¹⁸F-FDOPA: ¹⁸F-fluorodihydroxyphenylalanine; ¹⁸F-FDG: ¹⁸F-fluorodeoxyglucose; AADC: Aromatic L-amino acid decarboxylase; NE: Neuroendocrine.

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Figure 2 Biology-guided imaging algorithm for positron emission tomography tracer selection in patients with biochemical recurrence of medullary thyroid carcinoma. The algorithm integrates calcitonin doubling time and clinical context to guide first-line tracer choice among ¹⁸F-fluorodihydroxyphenylalanine, ¹⁸F-fluorodeoxyglucose, and Gallium-68-labelled somatostatin receptor positron emission tomography/computed tomography. MTC: Medullary thyroid carcinoma; DT: Doubling time; Ctn: Calcitonin; CEA: Carcinoembryonic antigen; ¹⁸F-FDOPA: ¹⁸F-fluorodihydroxyphenylalanine; PET/CT: Positron emission tomography/computed tomography; ¹⁸F-FDG: ¹⁸F-fluorodeoxyglucose; ⁶⁸Ga-SSTR: Gallium-68-labelled somatostatin receptor; FDOPA: Fluorodihydroxyphenylalanine; SSTR: Somatostatin receptor; PRRT: Peptide receptor radionuclide therapy; TKIs: Tyrosine kinase inhibitors.

Citation: Ahmed FW, Ahmed F. Positron emission tomography tracers in medullary thyroid carcinoma: Current evidence and emerging targets. World J Radiol 2026; 18(5): 120146
URL: https://www.wjgnet.com/1949-8470/full/v18/i5/120146.htm
DOI: https://dx.doi.org/10.4329/wjr.v18.i5.120146

Ahmed FW, Ahmed F. Positron emission tomography tracers in medullary thyroid carcinoma: Current evidence and emerging targets. World J Radiol 2026; 18(5): 120146 [DOI: 10.4329/wjr.v18.i5.120146]

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