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Mostowski R, de Pontville M, Bardet S, Ciappuccini R. False-Positive Radioiodine Uptake Related to Posttraumatic Scab Demonstrated by SPECT/CT in a Patient With Differentiated Thyroid Cancer. Clin Nucl Med 2025; 50:88-90. [PMID: 39529260 DOI: 10.1097/rlu.0000000000005563] [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: 11/16/2024]
Abstract
ABSTRACT A 20-year-old man with papillary thyroid cancer received a fourth radioiodine regimen to treat 131 I-avid lung metastases. Posttherapeutic whole-body scan revealed focal radioiodine uptake on the anterior region of the left lower limb that was not visible on previous whole-body scan and which suggested skin contamination. Visual examination of the left leg evidenced a posttraumatic scab caused by a fall 2 weeks before. Skin metastasis was ruled out. 131 I SPECT/CT acquisition ruled out bony uptake and confirmed that the skin uptake was related to the superficial scab.
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Affiliation(s)
- Romane Mostowski
- From the Department of Nuclear Medicine and Thyroid Unit, François Baclesse Comprehensive Cancer Centre, Caen, France
| | - Michel de Pontville
- Department of Medical Oncology and Dermatology Unit, François Baclesse Comprehensive Cancer Centre, Caen, France
| | - Stéphane Bardet
- From the Department of Nuclear Medicine and Thyroid Unit, François Baclesse Comprehensive Cancer Centre, Caen, France
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Makarewicz J, Rudzki J. Beard Contamination With 131 I Diagnosed by SPECT/CT in a Patient With Differentiated Thyroid Cancer. Clin Nucl Med 2024; 49:e595-e597. [PMID: 38768062 DOI: 10.1097/rlu.0000000000005282] [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: 05/22/2024]
Abstract
ABSTRACT Abnormal focal accumulation of 131 I is generally a reliable indicator of differentiated thyroid cancer metastases. However, many examples of false-positive 131 I uptake were reported, some of them of unusual nature. We report a case of 32-year-old man with differentiated thyroid cancer who underwent thyroid remnants ablation with radioiodine. An area of considerable 131 I uptake projecting onto lateral cervical areas was detected on posttherapy planar whole-body scan. Neck SPECT/CT scan was done to elucidate localization of the uptake, and activity was found in the patient's beard.
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Affiliation(s)
| | - Jan Rudzki
- From the Department of Nuclear Medicine and Oncological Endocrinology, Maria Sklodowska-Curie Memorial District Hospital, Zgierz, Poland
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Chua WM, Tang CYL, Loke KSH, Lam WWC, Yang SP, Lee MS, Hou W, Lim MYS, Lim KC, Chen RC. Differentiated Thyroid Cancer after Thyroidectomy. Radiographics 2024; 44:e240021. [PMID: 39235963 DOI: 10.1148/rg.240021] [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: 09/07/2024]
Abstract
The widespread use of neck US and other imaging modalities has contributed to a phenomenon of increased detection of differentiated thyroid cancer (DTC). Most of these cancers remain indolent, without requiring surgical intervention. Nonetheless, a subset of patients who require surgical treatment experience subsequent disease recurrence. This most commonly occurs in the cervical lymph nodes and thyroid bed, followed by distant metastasis to the lungs and bones. Because imaging is an integral part of postoperative surveillance, radiologists play a central role in the detection of recurrent tumors and in guiding treatment in these patients. US is the primary imaging modality used for postoperative evaluation. Other modalities such as CT, MRI, radioactive iodine imaging, and PET/CT aid in the accurate diagnosis and characterization of recurrent disease. Therefore, radiologists must have a thorough understanding of the utility of these imaging techniques and the imaging characteristics of recurrent DTC when interpreting these multimodality studies. The interpretation of imaging findings should also be correlated with the clinical status of patients and their biochemical markers to minimize interpretative errors. The authors present a broad overview of the postoperative evaluation of DTC, including its initial primary management, staging, and prognostication; clinical risk stratification for recurrent disease; postoperative surveillance with imaging and evaluation of biochemical markers; and management of recurrent DTC. Published under a CC BY 4.0 license. Supplemental material is available for this article.
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Affiliation(s)
- Wei Ming Chua
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Charlene Yu Lin Tang
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Kelvin S H Loke
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Winnie Wing-Chuen Lam
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Samantha Peiling Yang
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Melissa Shuhui Lee
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Wenlu Hou
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - May Yi Shan Lim
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Kheng Choon Lim
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
| | - Robert Chun Chen
- From the Department of Nuclear Medicine and Molecular Imaging, Division of Radiological Sciences, Singapore General Hospital, Outram Rd, Singapore 169608 (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L.); Department of Neuroradiology, Singapore General Hospital, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Radiological Sciences Academic Clinical Program, SingHealth Duke-NUS Academic Medical Centre, Singapore (W.M.C., C.Y.L.T., K.S.H.L., W.W.C.L., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); National Neuroscience Institute, Singapore (W.M.C., M.S.L., W.H., M.Y.S.L., K.C.L., R.C.C.); Department of Medicine, Division of Endocrinology, National University Hospital, Singapore (S.P.Y.); and Yong Loo Lin School of Medicine, National University of Singapore, Singapore (S.P.Y.)
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Liang C, Wu C, Liu L, Zhong J. Update on lacrimal apparatus dysfunction associated with differentiated thyroid cancer after I-131 therapy. Int Ophthalmol 2024; 44:257. [PMID: 38909080 DOI: 10.1007/s10792-024-03192-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/15/2024] [Indexed: 06/24/2024]
Abstract
PURPOSE The most prevalent lacrimal apparatus dysfunctions associated with differentiated thyroid cancer(DTC) after I-131 therapy are dry eye and nasolacrimal duct obstruction(NLDO), leading to ocular discomfort and lower quality of life for patients. It is crucial to diagnose and manage lacrimal apparatus dysfunction associated with I-131 therapy for DTC. Therefore, this review aims to comprehensively summarize and analyze the advances in mechanisms and therapeutic options underlying lacrimal apparatus dysfunction induced by I-131 therapy for DTC. METHODS A comprehensive search of CNKI, PubMed, and Wed of Science was performed from the database to December of 2023. Key search terms were "Thyroid cancer", "I-131", "Complications", "Dry eye", "Epiphora", "Tear", "Nasolacrimal duct" and "NLDO". RESULTS The research indicates that I-131 therapy for DTC causes damage to the lacrimal glands and nasolacrimal duct system, resulting in symptoms such as dry eye, epiphora, and mucoid secretions. Moreover, recent research has focused on exploring relevant risk factors of the condition and experimental and clinical treatments. However, there is some controversy regarding the mechanisms involved, whether it is due to the passive flow of I-131 in tears, active uptake of I-131 by the sodium-iodide symporter (NIS) in the lacrimal sac and nasolacrimal duct, or secondary metabolic and hormonal disturbances caused by I-131. CONCLUSION It is crucial for early detection and preventive measures by ophthalmologists and the need for further studies to elucidate the mechanisms underlying the disease.
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Affiliation(s)
- Chunlan Liang
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China
| | - Changlin Wu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China
| | - Lian Liu
- Department of Ophthalmology, The First Affiliated Hospital of Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China.
| | - Jingxiang Zhong
- Department of Ophthalmology, The Sixth Affiliated Hospital of Jinan University, No. 88, Changdong Road, Dongguan, 523573, China.
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Basso C, Colapinto A, Vicennati V, Gambineri A, Pelusi C, Di Dalmazi G, Rizzini EL, Tabacchi E, Golemi A, Calderoni L, Fanti S, Pagotto U, Repaci A. Radioiodine whole body scan pitfalls in differentiated thyroid cancer. Endocrine 2024:10.1007/s12020-024-03754-y. [PMID: 38498129 DOI: 10.1007/s12020-024-03754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE whole body scan (WBS) performed following diagnostic or therapeutic administration of I-131 is useful in patients with differentiated thyroid carcinoma. However, it can be falsely positive in various circumstances. We aimed to report a series of pitfalls in a clinical perspective. METHODS A search in the database PubMed utilizing the following terms: "false radioiodine uptake" and "false positive iodine 131 scan" has been made in January 2023. Among the 346 studies screened, 230 were included in this review, with a total of 370 cases collected. Physiological uptakes were excluded. For each patient, sex, age, dose of I-131 administered, region and specific organ of uptake and cause of false uptake were evaluated. RESULTS 370 cases of false radioiodine uptake were reported, 19.1% in the head-neck region, 34.2% in the chest, 14.8% in the abdomen, 20.8% in the pelvis, and 11.1% in the soft tissues and skeletal system. The origin of false radioiodine uptake was referred to non-tumoral diseases in 205/370 cases (55.1%), benign tumors in 108/370 cases (29.5%), malignant tumors in 25/370 cases (6.7%), and other causes in 32/370 cases (8.7%). CONCLUSIONS WBS is useful in the follow-up of patients with differentiated thyroid carcinoma, however it can be falsely positive in various circumstances. For this reason, it is critically important to correlate the scintigraphic result with patient's medical history, serum thyroglobulin levels, additional imaging studies and cytologic and/or histologic result.
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Affiliation(s)
- Cristina Basso
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Colapinto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Vicennati
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alessandra Gambineri
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Carla Pelusi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Elisa Lodi Rizzini
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Tabacchi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Arber Golemi
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Letizia Calderoni
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Stefano Fanti
- Nuclear Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Repaci
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
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Kamarulzaman K, Mohd Rohani MF, Mat Nawi N, Amir Hassan SZ. Concurrent Benign Iodine-Avid Thymic and Liver Cysts Mimicking Metastatic Disease on 131I Whole-Body Scintigraphy. Clin Nucl Med 2024; 49:250-252. [PMID: 38306377 DOI: 10.1097/rlu.0000000000005037] [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: 02/04/2024]
Abstract
ABSTRACT A 57-year-old woman received radioiodine therapy post total thyroidectomy for pT3aNxMx follicular thyroid carcinoma. Posttherapy 131I whole-body scan showed 131I concentration in the chest, mediastinum, and left upper thigh with stimulated thyroglobulin (Tg) of 89 μg/L. Subsequent radioiodine therapies showed persistent 131I accumulation in the anterior mediastinal soft tissue lesions and a hypodense segment VII liver lesion visualized on SPECT/CT, suggestive of iodine-avid metastatic disease despite the undetectable serum Tg (<1.0 μg/L) with no Tg antibody interference. Biopsy of the liver lesion revealed liver cyst, and consequent removal of the mediastinal lesions showed benign thymic cysts.
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Affiliation(s)
| | | | - Norazlina Mat Nawi
- Department of Nuclear Medicine, Oncology, and Radiotherapy, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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Yang J, Zhou P, Su X. False-Positive 131 I Uptake After Posttraumatic Scab in a Patient With Papillary Thyroid Carcinoma. Clin Nucl Med 2023; 48:e598-e599. [PMID: 37801578 DOI: 10.1097/rlu.0000000000004895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
ABSTRACT A 41-year-old woman with right papillary thyroid carcinoma underwent 131 I therapy (3.7 GBq). Posttherapy whole-body scintigraphy acquired 2 days later revealed a focus of intense activity in the anterior aspect of the left knee. The activity corresponding to the posttraumatic scab. Posttraumatic scab should be considerable a cause of false-positive whole-body scintigraphy findings.
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Affiliation(s)
- Jun Yang
- From the Department of Nuclear Medicine, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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Wall JS, Martin EB, Lands R, Ramchandren R, Stuckey A, Heidel RE, Whittle B, Powell D, Richey T, Williams AD, Foster JS, Guthrie S, Kennel SJ. Cardiac Amyloid Detection by PET/CT Imaging of Iodine ( 124I) Evuzamitide ( 124I-p5+14): A Phase 1/2 Study. JACC Cardiovasc Imaging 2023; 16:1433-1448. [PMID: 37940323 DOI: 10.1016/j.jcmg.2023.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND The noninvasive detection of cardiac amyloid, as well as deposits in other vital organs, is critical for early diagnosis and quantitative disease monitoring. Positron emission tomography is an intrinsically quantitative imaging modality suitable for high-resolution amyloid detection. OBJECTIVES This study sought to evaluate the safety and efficacy of a novel amyloid-reactive peptide, designated p5+14, labeled with iodine-124 (124I), in patients with diverse types of systemic amyloidosis. METHODS In a single-site, open label phase 1/2 study (NCT03678259), the safety, biodistribution, and sensitivity of a single intravenous infusion of 124I-evuzamitide was assessed in patients with systemic amyloidosis (n = 50), asymptomatic transthyretin sequence variant carriers (n = 2), and healthy volunteers (n = 5). Subjects were administered 1.4 ± 0.2 mg of 124I-evuzamitide (71.5 ± 12.4 MBq) and positron emission tomography/x-ray computed tomography images acquired at 5.2 hours (Q25-Q75: 4.9-5.4 hours) postinfusion. Images were assessed visually and semi-quantitatively for positive uptake of radiotracer in the heart and other major organs. RESULTS Uptake of 124I-evuzamitide in the heart and other abdominothoracic organs was consistent with the patient's clinical presentation and the type of amyloidosis. The patient- and cardiac-associated sensitivity for imaging and clinical observations was 93.6% (95% CI: 82.8%-97.8%) and 96.2% (95% CI: 81.8%-99.8%), respectively. Semi-quantitative uptake of the radiotracer correlated significantly with serum N-terminal pro-B-type natriuretic peptide measurements in patients with light chain-associated amyloidosis. Cardiac uptake was not observed in any healthy volunteers. The agent was well tolerated, with 1 drug-related adverse event and no deaths. CONCLUSIONS 124I-evuzamitide is an amyloid-binding radiotracer capable of detecting cardiac amyloid in patients with high sensitivity.
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Affiliation(s)
- Jonathan S Wall
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA.
| | - Emily B Martin
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Ronald Lands
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | | | - Alan Stuckey
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Bryan Whittle
- Department of Radiology, University of Tennessee Medical Center, Knoxville, Tennessee, USA
| | - Dustin Powell
- Hendersonville Radiologic Consultants, Hendersonville, North Carolina, USA
| | - Tina Richey
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Angela D Williams
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - James S Foster
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | | | - Stephen J Kennel
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
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Makarewicz M, Skierkowski W, Makarewicz J. Orbital Radioiodine Uptake in Epithelial Conjunctival Inclusion Cyst on Scintigraphy in a Patient With Differentiated Thyroid Cancer. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00577. [PMID: 37220222 DOI: 10.1097/rlu.0000000000004707] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
ABSTRACT Abnormal focal accumulation of 131I is generally a reliable indicator of differentiated thyroid cancer metastases. However, many examples of false-positive 131I uptake were reported but only a few with orbital accumulation of radioiodine. We report the case of a 68-year-old woman with differentiated thyroid cancer who underwent thyroid remnants ablation with radioiodine. A focus of considerable 131I uptake corresponding to a small, periorbital tumor was detected on posttherapy whole-body 131I scan and head SPECT/CT. The tumor was surgically removed, and pathology revealed a conjunctival inclusion cyst with no features of thyroid tissue. Orbital 131I uptake was not detected on follow-up scans.
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Barbaro D, Campennì A, Forleo R, Lapi P. False-positive radioiodine uptake after radioiodine treatment in differentiated thyroid cancer. Endocrine 2023:10.1007/s12020-023-03338-2. [PMID: 36928601 PMCID: PMC10018599 DOI: 10.1007/s12020-023-03338-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND AND PURPOSE False-positive radioiodine uptake can sometimes be observed with post-radioiodine treatment (RIT) whole body scanning. Radioiodine pitfall has often been reported as being caused by benign or inflammatory disease, or, in some cases, by tumor lesions. This paper reviews the possible causes of such false-positive imaging, and suggests possible reasons for suspecting these pitfalls. METHODS AND RESULTS Online databases, including MEDLINE (via PubMed), Embase, ISI Web of Science, Google Scholar, and Scopus, were systematically examined, using different keyword combinations: "radioiodine false-positive imaging", "131 I false-positive imaging" and " RAI false-positive imaging". An illustrative case was described. Excluding cases in which SPECT/CT was not performed, a total of 18 papers was found: 17 case reports and one series regarding false-positive iodine-131 uptake after RIT. CONCLUSIONS The prevalence of radioiodine pitfall was significantly reduced through the use of SPECT/CT imaging, though its possible presence has always to be taken into account. Inflammation, passive iodine accumulation, other tumors, and, sometimes, unknown causes can all potentially generate false-positive imaging. Missing detection of false-positive imaging could result in over-staging and inappropriate RIT or it could lead to the non-detection of other cancers. We examine the reasons for these possible pitfalls.
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Affiliation(s)
| | - Alfredo Campennì
- Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, University of Messina, 98121, Messina, Italy
| | | | - Paola Lapi
- U.O Endocrinology ASL North West, Tuscany, Italy
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11
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Aggarwal P, Seenivasagam RK, Sood A, Prashar S, Pathak P, Sachdeva N, Gupta P. Radioactive Iodine Uptake in Postoperative Seroma: A Cause for False Positivity. J Nucl Med Technol 2023; 51:68-69. [PMID: 36351798 DOI: 10.2967/jnmt.122.264569] [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: 06/24/2022] [Revised: 10/05/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
Besides the known physiologic uptake of 131I, the literature describes various false-positive findings on 131I scans in benign lesions, inflammation, traumatic sites, and postsurgical sites, to name a few. However, to the best of our knowledge, no study has shown false-positive uptake of 131I in a postoperative seroma at the postsurgical site. We describe such a case here.
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Affiliation(s)
| | | | - Ashwani Sood
- Department of Nuclear Medicine, PGIMER, Chandigarh, India;
| | - Sarika Prashar
- Department of Nuclear Medicine, PGIMER, Chandigarh, India
| | - Piyush Pathak
- Department of Biochemistry, PGIMER, Chandigarh, India
| | | | - Parikshaa Gupta
- Department of Cytopathology and Gynecologic Pathology, PGIMER, Chandigarh, India
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12
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Is there an added value for whole body scan combined with stimulated thyroglobulin testing for follow-up of differentiated thyroid cancer patients? Nucl Med Commun 2022; 43:663-668. [PMID: 35363221 DOI: 10.1097/mnm.0000000000001552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whole-body scan (WBS) is indicated for selected patients in the follow-up of differentiated thyroid cancer (DTC). AIM The aim of this study was to evaluate the incidence of positive WBS in patients with negative stimulated thyroglobulin (sTg), to define the clinical characteristics of this group, and the association with disease outcome. METHODS DTC patients who underwent surveillance with simultaneous sTg and WBS were included. RESULTS Two hundred seventy-two patients were included. Age at diagnosis was 46.5 ± 15.2 years, 79% were female. Mean duration of follow-up was 11.6 ± 6.8 years. Patients were categorised according to stimulation test results: sTg(-)/WBS(-) in 192/272 (70.6%); sTg(+) regardless of WBS results in 33/272 (12.1%); and sTg(-)/WBS(+) in 47/272 (17.3%) subjects. sTg > 10 mg/dl was considered positive. The three groups had similar demographic and pathologic characteristics. During follow-up, additional treatment was given in 77 patients (28.3%). Twelve (4.4%) developed distant metastases; 16 patients (5.8%) died. No deaths were disease-related. There was no difference in mortality rate between categories (P = 0.182). On multivariate analysis, additional treatment was associated with male gender (P = 0.046) and positive stimulation test results, either sTg (P < 0.001) or WBS (P < 0.001). Of the 47 WBS(+)/sTg(-) patients, 7(15%) were treated due to positive WBS results, including two who underwent additional surgery. CONCLUSION A substantial proportion of stimulation test results were discordant. There was a significant association between WBS results and administration of additional treatment. Routine WBS had additional value for a small proportion of patients with no other evidence for disease and no indication for WBS.
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Xiao L, Jiang L, Huang R, Tian R, Liu B. An Unusual False-Positive Uptake of Radioiodine Caused by Posttraumatic Superficial Scab. Clin Nucl Med 2022; 47:350-351. [PMID: 34739399 DOI: 10.1097/rlu.0000000000003956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACT A 22-year-old man with a history of recurrent papillary thyroid cancer underwent 131I therapy. Posttherapeutic whole-body scintigraphy was performed 5 days after administration of 5.5 GBq of 131I. The scintigraphy revealed increased activity in the left elbow. On physical examination, the patient had posttraumatic superficial scab at the site of the abnormal activity.
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Affiliation(s)
- Liu Xiao
- From the Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Abstract
ABSTRACT A 40-year-old woman with a history of papillary thyroid cancer underwent ablative 131I therapy. Postablation whole-body 131I scintigraphy revealed not only increased activity in the thyroid bed but also in the anterior part of the chest. SPECT/CT images localized the activity in the bilateral breast implants.
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15
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Walsh JP, Sims JB, Iranpour P. False-Positive Radioiodine Uptake From an Intracranial Surgical Clip. Clin Nucl Med 2022; 47:e279-e280. [PMID: 35025781 DOI: 10.1097/rlu.0000000000004002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 73-year-old man with papillary thyroid cancer underwent total thyroidectomy and bilateral neck dissections. He was subsequently treated with 131I. The posttherapy scan showed radioiodine uptake at the left supraorbital region, which localized to a metallic surgical clip. There was no evidence of metastasis in this area. This is not a commonly reported finding. Knowledge of this false-positive finding can help avoid unnecessary workup and treatment.
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Affiliation(s)
| | - Justin B Sims
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine
| | - Pooya Iranpour
- Departments of Diagnostic Radiology and Nuclear Medicine, Richard L. Roudebush VA Medical Center, Indianapolis, IN
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16
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Wall JS, Martin EB, Endsley A, Stuckey AC, Williams AD, Powell D, Whittle B, Hall S, Lambeth TR, Julian RR, Stabin M, Lands RH, Kennel SJ. First in Human Evaluation and Dosimetry Calculations for Peptide 124I-p5+14-a Novel Radiotracer for the Detection of Systemic Amyloidosis Using PET/CT Imaging. Mol Imaging Biol 2021; 24:479-488. [PMID: 34786667 DOI: 10.1007/s11307-021-01681-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/06/2021] [Accepted: 11/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Accurate diagnosis of amyloidosis remains a significant clinical challenge and unmet need for patients. The amyloid-reactive peptide p5+14 radiolabeled with iodine-124 has been developed for the detection of amyloid by PET/CT imaging. In a first-in-human evaluation, the dosimetry and tissue distribution of 124I-p5+14 peptide in patients with systemic amyloidosis. Herein, we report the dosimetry and dynamic distribution in the first three enrolled patients with light chain-associated (AL) amyloidosis. PROCEDURES The radiotracer was assessed in a single-site, open-label phase 1 study (NCT03678259). The first three patients received a single intravenous infusion of 124I-p5+14 peptide (≤37 MBq). Serial PET/CT imaging was performed during the 48 h post-infusion. Dosimetry was determined as a primary endpoint for each patient and gender-averaged mean values were calculated. Pharmacokinetic parameters were estimated from whole blood radioactivity measurements and organ-based time activity data. Lastly, the biodistribution of radiotracer in major organs was assessed visually and compared to clinically appreciated organ involvement. RESULTS Infusion of the 124I-p5+14 was well tolerated with rapid uptake in the heart, kidneys, liver, spleen, pancreas, and lung. The gender-averaged whole-body effective radiation dose was estimated to be 0.23 (± 0.02) mSv/MBq with elimination of the radioactivity via renal and gastrointestinal routes. The whole blood elimination t1/2 of 21.9 ± 7.6 h. Organ-based activity concentration measurements indicated that AUClast tissue:blood ratios generally correlated with the anticipated presence of amyloid. Peptide uptake was observed in 4/5 clinically suspected organs, as noted in the medical record, as well as six anatomic sites generally associated with amyloidosis in this population. CONCLUSION Peptide 124I-p5+14 rapidly distributes to anatomic sites consistent with the presence of amyloid in patients with systemic AL. The dosimetry estimates established in this cohort are acceptable for whole-body PET/CT imaging. Pharmacokinetic parameters are heterogeneous and consistent with uptake of the tracer in an amyloid compartment. PET/CT imaging of 124I-p5+14 may facilitate non-invasive detection of amyloid in multiple organ systems.
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Affiliation(s)
- Jonathan S Wall
- Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA.
| | - Emily B Martin
- Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | | | - Alan C Stuckey
- Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Angela D Williams
- Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Dustin Powell
- Department of Radiology, The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Bryan Whittle
- Department of Radiology, The University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Sarah Hall
- Department of Biochemistry and Cellular and Molecular Biology, University of Tennessee, Knoxville, TN, USA
| | - Tyler R Lambeth
- Department of Chemistry, University of California Riverside, Riverside, CA, USA
| | - Ryan R Julian
- Department of Chemistry, University of California Riverside, Riverside, CA, USA
| | | | - Ronald H Lands
- Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
| | - Stephen J Kennel
- Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN, 37920, USA
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Luo L, Wang J, Xia J, Zhang R, Yao X. False-Positive Uptake of 131I From Basal Cell Papilloma in a Patient With Metastatic Papillary Thyroid Cancer. Clin Nucl Med 2021; 46:358-360. [PMID: 33492860 DOI: 10.1097/rlu.0000000000003506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT A 64-year-old woman with metastatic papillary thyroid cancer underwent a total thyroidectomy followed by 2 courses of 131I therapy. The posttherapeutic whole-body scan after the second dose of 131I therapy showed multifocal bone metastasis. In addition, there is focal abnormal intense radiotracer uptake at the right inguinal region. SPECT/CT revealed that this abnormal focal radioactivity was from a superficial skin lesion. Further physical examination revealed a raised, approximately 1-cm, irregular grayish-brown lesion on the right groin skin. Histopathological examination confirmed the diagnosis of basal cell papilloma (seborrheic keratosis).
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Affiliation(s)
- Lingling Luo
- From the Department of Nuclear Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Jiaqiong Wang
- Department of Radiology, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL
| | - Junyong Xia
- From the Department of Nuclear Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Ran Zhang
- From the Department of Nuclear Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
| | - Xiaobo Yao
- From the Department of Nuclear Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People's Republic of China
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Liu S, Chen L, Zhang D, Cao C, Shao F. Variable 131I Activity in Renal Stone in a Patient With Thyroid Cancer. Clin Nucl Med 2021; 46:332-334. [PMID: 33492857 DOI: 10.1097/rlu.0000000000003504] [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: 11/27/2022]
Abstract
ABSTRACT A 42-year-old woman underwent 131I radiotherapy for thyroid papillary cancer. A focal elevated 131I activity in the right kidney was revealed on the initial whole-body posttherapeutic images, which was located in the region of a renal stone. However, on the follow-up 131I images acquired 6 months later, there was no longer any increased activity in the region of this stone, which had moved into right ureter. Our case indicates that the 131I activity accumulated in the region of urinary stone is due to stagnated radioactive urine rather than due to the stone per se.
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Affiliation(s)
- Shihong Liu
- From the Department of Nuclear Medicine, The People's Hospital of Tongliang District, Chongqing City, Chongqing
| | - Li Chen
- From the Department of Nuclear Medicine, The People's Hospital of Tongliang District, Chongqing City, Chongqing
| | - Deping Zhang
- From the Department of Nuclear Medicine, The People's Hospital of Tongliang District, Chongqing City, Chongqing
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Lu YL, Chen ST, Ho TY, Chan WH, Wong RJ, Hsueh C, Lin SF. Primary lung cancer with radioiodine avidity: A thyroid cancer cohort study. World J Clin Cases 2021; 9:71-80. [PMID: 33511173 PMCID: PMC7809679 DOI: 10.12998/wjcc.v9.i1.71] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/30/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A proportion of lung cancers show sodium/iodide symporter (NIS) expression. Lung cancers with NIS expression may uptake radioiodine (RAI) and show RAI-avid lesions on RAI scan for differentiated thyroid cancer (DTC) surveillance.
AIM To investigate the possibility of RAI uptake by lung cancer in a cohort with thyroid cancer.
METHODS RAI-avid lung cancers were analyzed using a prospectively maintained database of patients with thyroid cancer who were registered at a medical center between December 1, 1976 and May 28, 2018. NIS expression in lung cancer was assessed using immunohistochemical staining.
RESULTS Of the 5000 patients with thyroid cancer from the studied dataset, 4602 had DTC. During follow-up, 33 patients developed primary lung cancer. Of these patients, nine received an iodine-131 (131I) scan within 1 year before the diagnosis of lung cancer. One of these nine lung cancers was RAI-avid. NIS expression was evaluated, and three of the eight available lung cancers revealed NIS expression. The proportions of lung cancer cells with NIS expression were 60%, 15%, and 10%. The RAI-avid lung cancer had the highest level of expression (60%). The RAI-avid lung cancer had a spiculated border upon single-photon emission computed tomography/computed tomography, which led to an accurate diagnosis.
CONCLUSION A proportion of lung cancer demonstrates NIS expression and is RAI-avid. Clinicians should be aware of this possibility in the interpretation of RAI scintigraphy.
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Affiliation(s)
- Yu-Ling Lu
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Szu-Tah Chen
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Wen-Hui Chan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Institute for Radiological Research, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Richard J Wong
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States
| | - Chuen Hsueh
- Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shu-Fu Lin
- Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City 236, Taiwan
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
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van den Berg MF, Daminet S, Stock E, Vandermeulen E, Scheemaeker S, Campos M, Kooistra HS, Galac S, Duchateau L, Peremans K. Planar and single-photon emission computed tomography imaging in dogs with thyroid tumors: 68 cases. J Vet Intern Med 2020; 34:2651-2659. [PMID: 32978987 PMCID: PMC7694792 DOI: 10.1111/jvim.15908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022] Open
Abstract
Background Information on scintigraphy findings in dogs with thyroid neoplasia is scarce. The use of single‐photon emission computed tomography (SPECT) could improve detection of metastatic disease. Hypothesis/Objectives To describe planar and SPECT imaging findings in dogs with thyroid tumors, and to compare SPECT and thoracic radiography for metastasis detection. Animals Sixty‐eight dogs with thyroid neoplasia. Methods Retrospective study, search of medical records for dogs with thyroid neoplasia (2008‐2018). Results Thyroid scintigraphy was available from 68 dogs, of which 6 presented after surgical resection. Radionuclide uptake was increased in 56% of dogs, decreased in 24%, and comparable to that of the salivary glands in 13%. The remainder had multiple masses with variable uptake. A homogeneous uptake pattern was present in 16% and a heterogeneous uptake pattern in 73%. In 11% (all dogs with multiple masses), various uptake patterns were present. Thyroid tumors were well delineated in 55%. There was a significant association between hormone status and uptake pattern (P = .009), with a heterogeneous uptake pattern in the majority of euthyroid dogs, and hormone status and tumor circumscription (P = .003), with well‐circumscribed margins in the majority of hypothyroid and hyperthyroid dogs. Thoracic SPECT imaging was available in 39 dogs and identified metastatic lesions in 15 dogs. Thoracic radiographs were performed in 14 of these dogs, and detected metastases in 3 dogs. Conclusions and Clinical Importance SPECT imaging is a viable imaging technique to screen for thoracic metastasis and wider use of SPECT imaging is recommended in dogs with thyroid neoplasia.
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Affiliation(s)
- Marit F van den Berg
- Department of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sylvie Daminet
- Department of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Eva Vandermeulen
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Merelbeke, Belgium
| | - Stephanie Scheemaeker
- Department of Small Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Miguel Campos
- Department of Clinical Veterinary Science, Vetsuisse Faculty, Bern University, Bern, Switzerland
| | - Hans S Kooistra
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sara Galac
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Luc Duchateau
- Department of Nutrition, Genetics and Ethology, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Kathelijne Peremans
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics, Ghent University, Merelbeke, Belgium
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Bonjoc KJ, Young H, Warner S, Gernon T, Maghami E, Chaudhry A. Thyroid cancer diagnosis in the era of precision imaging. J Thorac Dis 2020; 12:5128-5139. [PMID: 33145090 PMCID: PMC7578495 DOI: 10.21037/jtd.2019.08.37] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Thyroid cancer affects 1.3% of the population with increasing rates of incidence over the last decade (approximately 2% per year). Although the overall prognosis is good in the differentiated subtypes, there has been a slow but steady increase in rate of deaths associated with thyroid cancer (approximately 0.7% per year over the last decade). Thyroid cancer is usually detected when: (I) patients feel a lump in the neck; (II) a routine clinical exam is performed; (III) an incidental thyroid nodule is identified on diagnostic imaging (e.g., CT neck or chest, carotid ultrasound, PET scan acquired for non-thyroid pathology). Identification of suspicious thyroid nodules results in further diagnostic work-up including laboratory assessment, further imaging, and biopsy. Accurate diagnosis is required for clinical staging and optimal patient treatment design. In this review, we aim to discuss utility of various imaging modalities and their role in thyroid cancer diagnosis and management. Additionally, we aim to highlight emerging diagnostic techniques that aim to improve diagnostic specificity and accuracy in thyroid cancer, thus paving way for precision medicine.
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Affiliation(s)
- Kimberley-Jane Bonjoc
- Department of Imaging Administration, City of Hope National Medical Center, Duarte, CA, USA
| | - Hannah Young
- Department of Imaging Administration, City of Hope National Medical Center, Duarte, CA, USA
| | - Susanne Warner
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Thomas Gernon
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Ellie Maghami
- Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Ammar Chaudhry
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA
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22
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Uptake Within Achilles Tendon on Posttherapy Radioiodine Whole-Body Scan Related to Gouty Tophus. Clin Nucl Med 2020; 45:e370-e372. [PMID: 32520497 DOI: 10.1097/rlu.0000000000003108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 66-year-old man with history of papillary thyroid cancer status post total thyroidectomy underwent I-radioiodine ablation. Posttherapy I whole-body scan revealed unexpected activity within the left posterior ankle. SPECT/CT localized the radioiodine uptake to a gouty tophus in the Achilles tendon.
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23
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Park JS, Kim DW, Shin GW, Park JY, Lee YJ, Choo HJ, Park HK, Ha TK, Kim DH, Jung SJ, Moon SH, Ahn KJ, Baek HJ. Prevalence and Features of Thyroglossal Duct Cyst on Ultrasonography, According to Radioactive Iodine Therapy: A Single-Center Study. Front Endocrinol (Lausanne) 2020; 11:188. [PMID: 32328033 PMCID: PMC7152667 DOI: 10.3389/fendo.2020.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: The relationship between radioactive iodine therapy (RIT) and prevalence of thyroglossal duct cysts (TGDC) on ultrasonography (US) has not been reported. We assessed the prevalence and US features of TGDC according to RIT. Methods: From July 2017 to June 2018, 3,146 subjects underwent thyroid or neck US at our center. The presence or absence of TGDCs was prospectively investigated based on real-time US examination. Among the 3,146 subjects, 261 subjects were excluded because of <18 years of age, unclear information of RIT, or the presence of a radiation therapy history to the neck. Eventually, 2,885 subjects were included in this study. Results: Of the 2,885 subjects finally included, 126 (4.4%) showed a TGDC on US. Those with RIT history showed a higher prevalence of TGDCs than those without (no statistical difference, p = 0.062). In 697 male subjects, there were statistical differences in type of surgery, RIT history, and session number of RIT between those with or without TGDCs (p < 0.0001). In 126 subjects with TGDCs, only sex showed a significant difference between those with or without RIT history (p = 0.015). However, there were no significant differences in the location, size, and shape of TGDCs (p > 0.05). The common US features of TGDC were suprahyoid location, ~1 centimeter, and flat-to-ovoid or round shape. Conclusions: RIT may increase the prevalence of TGDCs, particularly in men.
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Affiliation(s)
- Ji Sun Park
- Department of Nuclear Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Dong Wook Kim
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
- *Correspondence: Dong Wook Kim
| | - Gi Won Shin
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Young Park
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yoo Jin Lee
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jung Choo
- Department of Radiology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ha Kyoung Park
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Tae Kwun Ha
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Do Hun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Soo Jin Jung
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sung Ho Moon
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea
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24
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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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25
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García-Moreno RM, Escabias C, Utrilla C, Ruiz-Bravo E, Sánchez M, Lecumberri B. Orbital Radioiodine Uptake on Scintigraphy in a Patient with Thyroid Cancer. Eur Thyroid J 2019; 8:221-224. [PMID: 31602366 PMCID: PMC6738140 DOI: 10.1159/000499911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/26/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Orbital radioiodine uptake in patients with thyroid cancer is very uncommon with only a few reported cases, most of them being metastasis. The accumulation of 131I in nonthyroidal tissues and body fluids can lead to false-positive results in scintigraphy, which are sometimes difficult to differentiate from true metastases. CASE REPORT A post-therapy 131I whole-body (WBI) scintigraphy in an asymptomatic 57-year-old female with papillary thyroid carcinoma (PTC) previously treated with total thyroidectomy and 6 ablative radioiodine doses showed a focal uptake in the right eyeball region. The lesion, placed in the orbital space, was surgically removed, and histology revealed a conjunctival inclusion cyst. DISCUSSION Ocular and orbital metastases from thyroid cancer, as well as some non-neoplastic disorders or contamination, are possible causes for 131I uptake in the orbital region in scintigraphy. Conjunctival inclusion cyst is a condition associated with incidental 131I uptake that had not been reported before and should be ruled out as a non-metastatic cause of orbital radioiodine uptake in patients with PTC.
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Affiliation(s)
- Rosa M. García-Moreno
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain
- *Rosa M. García-Moreno, Endocrinology and Nutrition Department, Hospital Universitario La Paz, Paseo de la Castellana, No. 261, ES–28046 Madrid (Spain), E-Mail
| | - Cristina Escabias
- Nuclear Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Cristina Utrilla
- Radiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Ruiz-Bravo
- Pathology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Margarita Sánchez
- Ophthalmology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Lecumberri
- Endocrinology and Nutrition Department, Hospital Universitario La Paz, Madrid, Spain
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26
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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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27
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Abstract
A 72-year-old man underwent total thyroidectomy and radioiodine remnant ablation for papillary thyroid cancer in 2016. The posttherapy whole-body scan showed uptake in the neck, classified as residual thyroid tissue. Two years later, the patient came to our observation to perform a second radioiodine therapy for high levels of thyroglobulin. The planar posttherapy scan showed a focal radioiodine area in the neck. SPECT/CT diagnosed a voluminous esophageal diverticulum located in the upper third of the esophagus. A CT performed to discover the source of thyroglobulin excluded locoregional or distant metastases and confirmed the presence of a Zenker diverticulum.
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