FDG PET in the Follow-up of Differentiated Thyroid Cancer Comparison with Tc-99m Tetrofosmin and I-131 Whole Body Scintigraphy

Summary Aim: FDG-PET and MIBI-scintigraphy with SPECT were compared to [131I]-whole-body scintigraphy (WBS) and morphologic imaging in the follow-up of differentiated thyroid cancer. Their influence on therapy-planning was analysed. Methods: In 50 consecutive patients (papillary/ follicular/variants of a follicular carcinoma: 33/13/4; primary status: pTI/2/3/4: 3/16/9/22) FDG-PET of neck/chest and MIBI-whole-body scan including SPECT were performed during hypothyreosis and before WBS. Morphologic imaging was done by MRI in all and by CT of the lung without contrast media in 21 patients. Results: The complete extent of metastases was detected by FDG-PET in 11 and by MIBI-scintigraphy also in 11 of 22 patients with evidence of disease. The combined evaluation of WBS and FDG-PET as well as of WBS and MIBI-scintigraphy held true in 18 of 22 patients. Limiting FDG-PET or MIBI-scintigraphy to patients with elevated thyroglobulin (Tg)-levels and negative WBS only, would not, therefore, alter the sensitivity of this algorithm. The diagnostic benefit of FDG-PET and MIBI-scintigraphy was confined to lymph node metastases. The 1 cm limit for lymph node size in morphologically based imaging did not apply to FDG-PET and MIBI-scintigraphy. None of the 6 patients with small (<1 cm) pulmonary metastases showed either FDG- or MIBI-uptake, but could be diagnosed by spiral-CT. Conclusion: WBS cannot be replaced by FDG-PET or MIBI-scintigraphy; neither of the latter was better than the other. Rising Tg-levels, negative WBS and the exclusion of pulmonary metastases by spiral-CT define the constellation in which FDG-PET and MIBI-scintigraphy can provide data of therapeutic relevance.

Download Full-text

The role of FDG-PET in localization of recurrent lesions of differentiated thyroid cancer (DTC) in patients with asymptomatic hyperthyroglobulinemia in a real clinical practice

Acta Endocrinologica ◽

10.1530/eje-16-0360 ◽

2016 ◽

Vol 175 (5) ◽

pp. 379-385 ◽

Cited By ~ 4

Author(s):

A Kukulska ◽

J Krajewska ◽

Z Kołosza ◽

E Paliczka-Cies´lik ◽

Z Puch ◽

...

Keyword(s):

Thyroid Cancer ◽

Fdg Pet ◽

Differentiated Thyroid Cancer ◽

Prognostic Significance ◽

Whole Body ◽

Asymptomatic Patients ◽

Pet Ct ◽

Fdg Pet Ct ◽

Tsh Stimulation

IntroductionAvailable methods, including serum thyroglobulin (Tg) measurement and whole-body scan (WBS) performed after radioiodine administration, allow for a precise diagnostics in differentiated thyroid cancer (DTC). However, some asymptomatic patients demonstrate negative WBS despite a high Tg serum concentration. In these subjects, fluorodeoxyglucose-positron emission tomography (FDG-PET) should be considered. The primary aim of our study was to evaluate a diagnostic value of FDG-PET in asymptomatic hyperthyroglobulinemia. The secondary one was to determine a prognostic value of a negative FDG-PET result in DTC patients with elevated Tg level.MaterialOne hundred and ten FDG-PET/CT scans were retrospectively analyzed, 85 scans were done under TSH stimulation and 25 on LT4suppressive therapy. Follow-up ranged between 4 and 9 years.ResultsThe first FDG-PET/CT detected cancer foci in 49 subjects with a global sensitivity of 45%. When the sensitivity was evaluated with reference to TSH stimulation and suppression, its values were 50 and 28% respectively. In 42 patients, FDG-PET failed to diagnose the reason for elevated Tg level. During further follow-up, in 17 of them, DTC recurrence was detected by other methods (CT, MRI, US). Fourteen subjects with asymptomatic hyperthyroglobulinemia were free of DTC progression for at least 4 years.ConclusionsFDG-PET in DTC patients with asymptomatic hyperthyroglobulinemia constitutes a valuable diagnostic tool. Negative FDG-PET demonstrated a limited prognostic significance, as only every third patient did not show DTC progression. Moreover, negative FDG-PET does not justify less strict DTC monitoring, because it is related to 40% risk of relapse during the 5-year follow-up.

Download Full-text

FDG-PET, I-131 and MIBI Scintigraphy in the Follow-Up of Differentiated Thyroid Cancer

Radioactive Isotopes in Clinical Medicine and Research ◽

10.1007/978-3-0348-7772-5_9 ◽

1997 ◽

pp. 63-68

Author(s):

F. Grünwald ◽

H.-J. Biersack ◽

E. Klemm ◽

C. Menzel ◽

H. Bender ◽

...

Keyword(s):

Thyroid Cancer ◽

Fdg Pet ◽

Differentiated Thyroid Cancer ◽

Mibi Scintigraphy

Download Full-text

Serum thyroglobulin concentrations and whole-body radioiodine scan in follow-up of differentiated thyroid cancer after thyroid ablation.

BMJ ◽

10.1136/bmj.2.6185.298 ◽

1979 ◽

Vol 2 (6185) ◽

pp. 298-300 ◽

Cited By ~ 46

Author(s):

S C Ng Tang Fui ◽

R Hoffenberg ◽

M N Maisey ◽

E G Black

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Whole Body ◽

Serum Thyroglobulin ◽

Thyroid Ablation ◽

Radioiodine Scan

Download Full-text

18F-FDG PET in the Management of Differentiated Thyroid Cancer in Patients with High Serum Thyroglobulin and Negative I-131 Whole Body Scan.

10.1210/endo-meetings.2010.part1.p12.p1-573 ◽

2010 ◽

pp. P1-573-P1-573

Author(s):

R G Martins ◽

A P Santos ◽

J Couto ◽

A P Barbosa ◽

J Teixeira ◽

...

Keyword(s):

Thyroid Cancer ◽

Fdg Pet ◽

Differentiated Thyroid Cancer ◽

High Serum ◽

Whole Body ◽

Whole Body Scan ◽

Body Scan ◽

Serum Thyroglobulin ◽

18F Fdg

Download Full-text

Long-Term Follow-Up of Patients With Differentiated Thyroid Cancer Who had Negative 131I Whole-Body Scan at First Evaluation After Treatment

Clinical Nuclear Medicine ◽

10.1097/rlu.0b013e31829f8c71 ◽

2013 ◽

Vol 38 (10) ◽

pp. 765-769 ◽

Cited By ~ 6

Author(s):

Luciana Souza Cruz Caminha ◽

Denise Prado Momesso ◽

Fernanda Vaisman ◽

Rossana Corbo ◽

Mario Vaisman

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Whole Body ◽

Whole Body Scan ◽

Body Scan ◽

Long Term Follow Up

Download Full-text

Should the Place of Radioactive Iodine Whole Body Scintigraphy in Follow-up of Differentiated Thyroid Cancer Reevaluated in the Era of SPECT/CT?

Nuclear Medicine Seminars ◽

10.4274/nts.galenos.2021.0006 ◽

2021 ◽

Vol 7 (1) ◽

pp. 70-79

Author(s):

Mine Araz ◽

Nuriye Özlem Küçük

Keyword(s):

Thyroid Cancer ◽

Differentiated Thyroid Cancer ◽

Radioactive Iodine ◽

Whole Body

Download Full-text

Incremental diagnostic value of [18F]tetrafluoroborate PET-CT compared to [131I]iodine scintigraphy in recurrent differentiated thyroid cancer

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-020-04727-9 ◽

2020 ◽

Vol 47 (11) ◽

pp. 2639-2646 ◽

Cited By ~ 2

Author(s):

Matthias Dittmann ◽

José Manuel Gonzalez Carvalho ◽

Kambiz Rahbar ◽

Michael Schäfers ◽

Michael Claesener ◽

...

Keyword(s):

Thyroid Cancer ◽

Fdg Pet ◽

Differentiated Thyroid Cancer ◽

Imaging Techniques ◽

Diagnostic Value ◽

Whole Body ◽

Sodium Iodide Symporter ◽

Cervical Lymph Nodes ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Introduction Efficient therapy of recurrent differentiated thyroid cancer (DTC) is dependent on precise molecular imaging techniques targeting the human sodium iodide symporter (hNIS), which is a marker both of thyroid and DTC cells. Various iodine isotopes have been utilized for detecting DTC; however, these come with unfavorable radiation exposure and image quality ([131I]iodine) or limited availability ([124I]iodine). In contrast, [18F]tetrafluoroborate (TFB) is a novel radiolabeled PET substrate of hNIS, results in PET images with high-quality and low radiation doses, and should therefore be suited for imaging of DTC. The aim of the present study was to compare the diagnostic performance of [18F]TFB-PET to the clinical reference standard [131I]iodine scintigraphy in patients with recurrent DTC. Methods Twenty-five patients with recurrent DTC were included in this retrospective analysis. All patients underwent [18F]TFB-PET combined with either CT or MRI due to newly discovered elevated TG levels, antiTG levels, sonographically suspicious cervical lymph nodes, or combinations of these findings. Correlative [131I]iodine whole-body scintigraphy (dxWBS) including SPECT-CT was present for all patients; correlative [18F]FDG-PET-CT was present for 21 patients. Histological verification of [18F]TFB positive findings was available in 4 patients. Results [18F]TFB-PET detected local recurrence or metastases of DTC in significantly more patients than conventional [131I]iodine dxWBS and SPECT-CT (13/25 = 52% vs. 3/25 = 12%, p = 0.002). The diagnosis of 6 patients with cervical lymph node metastases that showed mildly increased FDG metabolism but negative [131I]iodine scintigraphy was changed: [18F]TFB-PET revealed hNIS expression in the metastases, which were therefore reclassified as only partly de-differentiated (histological confirmation present in two patients). Highest sensitivity for detecting recurrent DTC had the combination of [18F]TFB-PET-CT/MRI with [18F]FDG-PET-CT (64%). Conclusion In the present cohort, [18F]TFB-PET shows higher sensitivity and accuracy than [131I]iodine WBS and SPECT-CT in detecting recurrent DTC. The combination of [18F]TFB-PET with [18F]FDG-PET-CT seems a reasonable strategy to characterize DTC tumor manifestations with respect to their differentiation and thereby also individually plan and monitor treatment. Future prospective studies evaluating the potential of [18F]TFB-PET in recurrent DTC are warranted.

Download Full-text