Frequency of diagnostic dilemmas in 131I whole body scanning

2003 ◽  
Vol 42 (02) ◽  
pp. 55-62 ◽  
Author(s):  
A. Staudenherz ◽  
Th. Leitha
Keyword(s):  
Thyroid Tissue ◽  
Residual Activity ◽  
Diagnostic Procedures ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
High Dose ◽  
Daily Routine ◽  
Body Scanning ◽  
Significant Difference ◽  
Kidney Metastasis

SummaryAim: The specific excretion pathways of iodine may cause several diagnostic pitfalls. Information concerning their relative frequency and possible consequences in daily routine is scarce. Methods: A total of 500 131I whole-body scans from 300 consecutive patients with differentiated thyroid cancer of two centers were analyzed. The reports were validated with other diagnostic findings during follow-up for 12 to 85 months. 126 scans (25.2%) were performed at the time of discharge after high dose 131I therapy (2960-11100 MBq). Residual activity was approximately 185 MBq 131I at the time of imaging. 374 scans (74.8%) were performed in ambulatory patients 48 h after oral administration of 74 MBq131I. All patients revealed TSH concentrations >35 U/ml. Results: A computerized literature search revealed 74 entities that may cause a false-positive whole body scan, from which 12 were present in our cohort. The uptake patterns could be epitomized into nine clinical settings. Apart from the significantly higher frequency of cervical activity in residual thyroid tissue in patients after high dose therapy no statistically significant difference was found between high and low dose patients. The most frequent combination was stomach and colon activity, which was seen in 15.3% of all scans. Additional images or diagnostic procedures were necessary in 59.3%. Only one patient with a kidney metastasis was initially misinterpreted. The major clinical problems included: contamination, superimposed intestinal retention, hot nose, isolated peripheral metastasis, unexpected breast activity and kidney metastasis. Conclusion: 131I whole-body scanning has to be performed with painstaking precision and full awareness of even the rarest pitfalls in order to remain a sensitive and specific technique for diagnosing metastases from differentiated thyroid carcinoma.

scholarly journals Optimization of Predictive Performance for the Therapeutic Response Using Iodine Scan-Corrected Serum Thyroglobulin in Patients with Differentiated Thyroid Carcinoma

Cancers ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. 262
Author(s):  
Su Woong Yoo ◽  
Md. Sunny Anam Chowdhury ◽  
Subin Jeon ◽  
Sae-Ryung Kang ◽  
Sang-Geon Cho ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Thyroid Tissue ◽  
Predictive Performance ◽  
Response Prediction ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
Serum Thyroglobulin ◽  
Focal Uptake ◽  
Uptake Pattern ◽  
Iodine Scan

We investigated whether the performance of serum thyroglobulin (Tg) for response prediction could be improved based on the iodine uptake pattern on the post-therapeutic I-131 whole body scan (RxWBS) and the degree of thyroid tissue damage with radioactive iodine (RAI) therapy. A total of 319 patients with differentiated thyroid carcinoma who underwent total thyroidectomy and RAI therapy were included. Based on the presence/absence of focal uptake at the anterior midline of the neck above the thyroidectomy bed on RxWBS, patients were classified into positive and negative uptake groups. Serum Tg was measured immediately before (D0Tg) and 7 days after RAI therapy (D7Tg). Patients were further categorized into favorable and unfavorable Tg groups based on the prediction of excellent response (ER) using scan-corrected Tg developed through the stepwise combination of D0Tg with ratio Tg (D7Tg/D0Tg). We investigated whether the predictive performance for ER improved with the application of scan-corrected Tg compared to the single Tg cutoff. The combined approach using scan-corrected Tg showed better predictive performance for ER than the single cutoff of D0Tg alone (p < 0.001). Therefore, scan-corrected Tg can be a promising biomarker to predict the therapeutic responses after RAI therapy.

scholarly journals Reproducibility of 24 h energy expenditure measurements using a human whole body indirect calorimeter

1987 ◽  
Vol 57 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Janna O. De Boer ◽  
Aren J. H. Van Es ◽  
Joop E. Vogt ◽  
Joop M. A. Van Raaij ◽  
Joseph G. A. J. Hautvast
Keyword(s):  
Energy Expenditure ◽  
Coefficient Of Variation ◽  
Weight Maintenance ◽  
Metabolizable Energy ◽  
Whole Body ◽  
Time Interval ◽  
Daily Routine ◽  
Individual Level ◽  
Period 2 ◽  
Significant Difference

1. Ten female subjects completed two similar experimental procedures (periods 1 and 2) to obtain values of reproducibility of energy intake and 24 h energy expenditure (24hEE) measurements in a whole body indirect calorimeter. The periods consisted of consumption of a provided weight-maintenance diet for 6–8 d, faeces and urine collection during the last 4 d and occupation of the calorimeter during the last 3 d. The daily routine inside the calorimeter simulated a sedentary day in normal life with some physical activity: 8 h sleep, 75 min bicycling and the remaining time spent on sedentary activities. The metabolizable energy (ME) content of the diet (14% energy as protein, 46% energy as carbohydrate, 40% energy as fat) was calculated using food tables. The actual ME intake as well as digestibility and metabolizability of the diet were obtained later by analyses of food, faeces and urine for energy. Three consecutive 24hEE measurements were performed during the stay in the calorimeter in each period. The time interval between the two periods varied from 2 to 24 months. Reproducibility was assessed at group and individual level.2. Mean digestibility and metabolizability of the diet showed no significant difference between periods. The within-subject coefficient of variation of metabolizability between periods was 1.7%.3. Mean 24hEE (MJ) over 3 d did not differ between period 1 (8.78 (SD 0.63)) and period 2 (8.73 (SD 0.66)). The within-subject coefficient of variation in mean 24hEE over three successive days between periods was 3.1% but decreased, after deletion of values for subjects who were less adapted to the calorimeter, to 1.9%.4. The results are discussed with regard to length of trial and the number of subjects required to test a difference in energy metabolism using whole body indirect calorimeters.

THE SITES OF IODINE ACCUMULATION AND THE IODOAMINO ACIDS IN THE THYROID AND PLASMA OF PLAICE (PLEURONECTES PLATESSA L.)

1969 ◽  
Vol 43 (4) ◽  
pp. 643-NP ◽  
Author(s):  
R. H. OSBORN ◽  
T. H. SIMPSON
Keyword(s):  
Thin Layer ◽  
Blood Plasma ◽  
Thin Layer Chromatography ◽  
Thyroid Tissue ◽  
Whole Body ◽  
Thyroid Activity ◽  
Body Scanning ◽  
Pleuronectes Platessa ◽  
Layer Chromatography

SUMMARY Whole body scanning and radioautography of plaice injected with 125I failed to show extra-pharyngeal sites of thyroid activity. The constituent iodoamino acids of thyroid tissue and of blood plasma have been identified by thin-layer chromatography of the parent compounds and of their derivatives, the preparation of which is described. Thyroid tissue has been found to contain 3,5,3′-tri-iodothyronine (T3), thyroxine (T4), 3-iodotyrosine (MIT) and 3,5-di-iodotyrosine (DIT). T3 and T4 were the only iodoamino acids detected in plasma.

scholarly journals Long-Term Oncological Outcome Comparison between Intermediate- and High-Dose Radioactive Iodine Ablation in Patients with Differentiated Thyroid Carcinoma: A Propensity Score Matching Study

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Kwangsoon Kim ◽  
Ja Seong Bae ◽  
Jeong Soo Kim
Keyword(s):  
Propensity Score ◽  
Thyroid Carcinoma ◽  
Propensity Score Matching ◽  
Radioactive Iodine ◽  
Differentiated Thyroid Carcinoma ◽  
High Dose ◽  
Preoperative Serum ◽  
Significant Difference ◽  
Intermediate Dose

Background. Radioactive iodine (RAI) ablation is recommended for most patients with differentiated thyroid carcinoma (DTC) after total thyroidectomy (TT). We aimed to compare long-term outcomes between intermediate-dose (100 mCi) and high-dose (150 mCi) RAI ablation therapy in patients with DTC using propensity score matching analysis. Methods. This was a retrospective study of 1448 patients with DTC who underwent RAI ablation after TT. Propensity score matching was performed using the extent of operation, tumor size, extrathyroidal extension, multifocality, lymphatic invasion, vascular invasion, perineural invasion, number of positive lymph nodes (LNs), ATA risk stratification system, T stage, N stage, TNM stage, preoperative serum Tg and TgAb levels, and post-RAI serum Tg and TgAb levels. Results. Recurrence rates in the intermediate- and high-dose groups were 3.1% and 5.6%, respectively. After propensity score matching, LN ratio >0.22 (HR, 2.915; 95% CI, 1.228–6.918; p = 0.015 ) and serum Tg >10 ng/mL after RAI (HR, 3.976; 95% CI, 1.839–8.595; p < 0.001 ) were significant predictors of recurrence. Kaplan–Meier analysis showed no significant difference in DFS before or after propensity score matching ( p = 0.074 and p = 0.378 , respectively). Conclusions. Intermediate-dose RAI ablation for the adjuvant treatment of DTC is sufficient as compared to high-dose RAI ablation. Further prospective or multicenter studies should be conducted to clarify the prognosis of intermediate-dose RAI ablation.

Tc-99m-Tetrofosmin Scintigraphy: An Alternative Scintigraphic Method for Following up Differentiated Thyroid Carcinoma

1996 ◽  
Vol 35 (06) ◽  
pp. 230-265 ◽  
Author(s):  
E. Kresnik ◽  
P. Mikosch ◽  
W. Pipam ◽  
Iris Gomez ◽  
P. Lind ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Imaging Modality ◽  
Region Of Interest ◽  
Differentiated Thyroid Carcinoma ◽  
Whole Body ◽  
High Dose ◽  
Post Injection ◽  
Detection Rates ◽  
Time Activity

Summary Aim: The usefulness of the myocardial perfusion agent, Tc-99m-tetrofosmin (Myoview®) in the follow-up of differentiated thyroid carcinoma was evaluated in a clinical study of 15 patients, primary treated with thyroidectomy and high-dose I-131-therapy (2960-3700 MBq), 12 with suspected recurrence and metastases and three patients without any suspicion and compared with other non-specific tracers like TI-201 and Tc-99m-sestamibi. Method: Twelve patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml (group A), four of these had negative I-131 scans, and three patients with Tg levels less than 10 ng/ml (group B) were examined under TSH suppressive L-Thyroxine treatment. Whole body scans were taken with TI-201 (74 MBq; 20 min post injection), Tc-99m-sestamibi (370 MBq; 20-60 min post injection) and Tc-99m-tetrofosmin (370 MBq; 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 150 min post injection) were evaluated using the region of interest approach. Results: Compared with TI-201 (T/BG: 1.59, ± 0.396), Tc-99m-tetrofosmin showed slightly but not significant better T/BG ratios and detection rates (T/BG: 1.76, ± 0.345).Tc-99m-sestamibi (1.51, ± 0.31 p = 0.05) showea significantly lower values than Tc-99m-tetrofosmin. Conclusion: In the light of these results, scintigraphy with Tc-99m-tetrofosmin seems to be a possibly sensitive imaging modality in the follow-up of DTC with possible advantages concerning T/Bg ratio, background clearance, detection rate and dosimetry compared with TI-201 and Tc-99m-sestamibi, especially in patients with elevated Tg level and no iodine uptake , but further investigations are needed to confirm our preliminary results.

Elevated thyroglobulin levels and negative I-131 whole body scans: Six-year experience in United Arab Emirate

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16508-16508
Author(s):  
A. Uttamchandani ◽  
A. M. Maarraoui ◽  
N. M. Attia ◽  
H. A. Latif ◽  
M. A. Bakir ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cell Cancer ◽  
Thyroid Tissue ◽  
Elevated Serum ◽  
Lymphatic Invasion ◽  
Whole Body ◽  
High Dose ◽  
Serum Thyroglobulin ◽  
Female Ratio ◽  
Post Therapy

16508 Purpose: This is a retrospective study of thyroid cancer patients seen at Oncology Department at Mafraq Hospital/UAE from 1/1999 to 12/2005. Clinical data, prognostic factors and treatment outcomes were studied, special emphasis was put on patients with elevated Serum Thyroglobulin (TG) and negative I-131 whole body scans. Patients and Methods: Total of 144 patients were fully evaluated, intent to treat analysis was used. All patients were treated surgically and post-op thyroid technician 99 scan were performed. I-131 ablation was given if the tumor size was =1 cm or if =1 cm (micropapillary) and multi-focal. Post ablation scan was done on day 10 and thyroxin was given in suppressive doses. Periodic evaluations were done with TG level, I-131 whole body scan, neck US and CXR. Plain CT scans and PET scans were done in selected cases. Results: Male to female ratio 1:2.42, non-smokers were 90%, non-alcoholics were 99%, Diabetes and Hypertension were associated in 28% of cases, family history of thyroid cancer was noted in 8%, papillary carcinoma was seen in 85.8%, follicular cancer in 11.6%, hurthel cell cancer in 0.83% and medullary cancer in 0.17%. Vascular and lymphatic invasion was noted in 29% of all cases. Interesting all patients with vascular or lymphatic invasion relapsed locally or distantly. Post-operative thyroid scan showed residual thyroid tissue in 96% of cases. During follow up TG levels (cut off 5.0 ng/ml) were elevated in 52 patients (37% cohort). Diagnostic I-131 scans were done in 36 patients and were positive in 24 patients (67%) and negative in 12 patients (33%). In the 12 patient group of research interest with elevated TG and negative I-131 whole body scans, 9 received high dose I-131 therapy. Of these patients 8 (88%) showed positive post therapy scan and 1 (12%) showed negative post therapy scan. Conclusion: 1. TG is more sensitive marker than diagnostic I-131 scan in making treatment decisions. 2. Lympho vascular invasion has adverse prognostic value. No significant financial relationships to disclose.

scholarly journals Outcome in patients with differentiated thyroid cancer with negative diagnostic whole-body scanning and detectable stimulated thyroglobulin

2003 ◽  
pp. 589-596 ◽  
Author(s):  
KM van Tol ◽  
PL Jager ◽  
EG de Vries ◽  
DA Piers ◽  
HM Boezen ◽  
...  
Keyword(s):  
Thyroid Hormone ◽  
Tumor Location ◽  
Differentiated Thyroid Carcinoma ◽  
Post Treatment ◽  
Whole Body ◽  
High Dose ◽  
Serum Thyroglobulin ◽  
Thyroid Hormone Withdrawal ◽  
Iodine Treatment

BACKGROUND: Management of patients with differentiated thyroid carcinoma with negative diagnostic radioiodide scanning and increased serum thyroglobulin (Tg) concentrations is a widely debated problem. High-dose iodine-131 treatment of patients who have a negative (131)I diagnostic whole-body scan (WBS) is advocated. However, the therapeutic benefit of this "blind" treatment is not clear. OBJECTIVE: To investigate the course of serum Tg during thyroid hormone suppression therapy (Tg-on) and clinical outcome in patients with negative diagnostic (131)I scanning and increased serum Tg concentrations during thyroid hormone withdrawal (Tg-off), after treatment with high-dose (131)I. DESIGN: Retrospective single-center study. METHODS: Fifty-six patients were treated with a blind therapeutic dose of 150 mCi (131)I. Median follow-up from this treatment until the end of observation was 4.2 Years (range 0.5-13.5 Years). RESULTS: The post-treatment WBS revealed (131)I uptake in 28 patients, but none in the remaining 28 patients. In this study the Tg-on values did not change after treatment in either the positive or the negative post-treatment WBS group. During follow-up, 18 of the 28 patients with a positive post-treatment WBS achieved complete remission, compared with 10 of the 28 patients with a negative post-treatment WBS. Nine patients in the negative group died, but no patients died in the positive post-treatment group (P=0.001). CONCLUSIONS: High-dose iodine treatment in diagnostically negative patients who have a negative post-treatment scan seems to confer no additional value for tumor reduction and survival. In patients with a positive post-treatment scan, high-dose iodine treatment can be used as a diagnostic tool to identify tumor location, and a therapeutic effect may be present in individual cases.

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