The Use of 124-I-PET/CT Whole Body and Lesional Dosimetry in Differentiated Thyroid Cancer

2000 ◽  
Author(s):  
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Pet Ct

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

2020 ◽  
Vol 47 (11) ◽  
pp. 2639-2646 ◽  
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.

The role of FDG-PET/CT in differentiated thyroid cancer patients with negative iodine-131 whole-body scan and elevated anti-Tg level

2014 ◽  
Vol 28 (10) ◽  
pp. 970-979 ◽  
Author(s):  
Sertac Asa ◽  
Sabire Yılmaz Aksoy ◽  
Betül Vatankulu ◽  
Anar Aliyev ◽  
Lebriz Uslu ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Cancer Patients ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Whole Body Scan ◽  
Pet Ct ◽  
Iodine 131 ◽  
Fdg Pet Ct

Diagnostic value and therapeutic impact of 18F-FDG-PET/CT in differentiated thyroid cancer

2013 ◽  
Vol 52 (01) ◽  
pp. 1-6 ◽  
Author(s):  
M. Dietlein ◽  
D. Schmidt ◽  
T. Kuwert ◽  
R. Dorn ◽  
J. Sciuk ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Tumour Tissue ◽  
Therapeutic Management ◽  
Whole Body ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct ◽  
The Impact

SummaryThe clinical significance of 18F-FDG-PET/CT in the follow-up of patients with differentiated thyroid carcinoma was evaluated and the results were compared with those of 18F-FDGPET, 131I-whole-body scintigraphy including SPECT/CT (WBS) and ultrasound. In addition, it was the aim to investigate the impact of 18F-FDG-PET/CT on the therapeutic management. Patients, methods: 327 patients (209 women, 118 men; mean age 53 ± 18 years) with differentiated thyroid cancer (242 papillary, 75 follicular, 6 mixed, 1 Hürthle cell and 3 poorly differentiated tumours) were analyzed retrospectively at four tertiary referral centres. 289 18F-FDG-PET/CT and 118 18F-FDG-PET studies were performed in these patients between 2007 and 2010. In addition, an overall clinical evaluation was performed, including cytology, histology, thyroglobulin level, ultrasound, WBS, and subsequent clinical course in order to compare the molecular imaging results. Finally, the change in therapeutic management due to findings of 18F-FDG-PET/CT was investigated. Results: The sensitivity of 18F-FDG-PET/CT was 92%, the specificity was 95%. Sensitivity and specificity of 18F-FDG-PET alone were 67% and 93%, respectively. WBS showed a sensitivity of 65% and a specificity of 94%. The corresponding values of ultrasound were 37% and 94%, respectively. The sensitivity of 18F-FDG-PET/CT in the group of patients with a negative WBS (n=194) amounted to 96%. When 18F-FDG-PET/CT and WBS were considered in combination, tumour tissue was missed in only 2 out of 133 patients; when 18F-FDG-PET and WBS were combined, tumour tissue was missed in 1 out of 24 patients. 18F-FDG-PET/CT resulted in management change in 43% (n=57/133) with a decision on surgical approach in 20% (n=27/133). Conclusions: 18F-FDG-PET/CT is superior to 18F-FDG-PET alone in patients with differentiated thyroid cancer and has a direct impact on the therapeutic management of patients with suspected local recurrence or metastases, particularly in those with negative WBS.

scholarly journals Radionuclide monitoring of targeted therapy of iodine-negative differentiated thyroid cancer

2021 ◽  
Vol 29 (1) ◽  
pp. 141-155
Author(s):  
O. I. Solodiannykova ◽  
Ya. V. Kmetyuk ◽  
V. V. Danylenko ◽  
H. H. Sukach
Keyword(s):  
Thyroid Cancer ◽  
Targeted Therapy ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Differentiated Thyroid Cancer ◽  
Kinase Inhibitors ◽  
Whole Body ◽  
Pet Ct ◽  
18F Fdg ◽  
99Mtc Mibi

Background. Current management of treating iodine-negative metastases of differentiated thyroid cancer has its features. In recent years, tyrosine kinase inhibitors (sorafenib, sunitinib) have been registered and indicated to treat refractory forms of differentiated thyroid cancer in Ukraine. However, there were only few studies dealing with cytologic aspects of predicting radioiodine resistance of papillary thyroid cancer, development of radionuclide monitoring and diagnostic algorithm to detect relapses and metastases in patients with iodine-negative forms of differentiated thyroid cancer. At the same time, scientific and clinical aspects of treatment of radioiodineresistant differentiated thyroid cancer in Ukrainian oncology and radiology are barely studied. Thus, the status of treatment and post-therapeutic monitoring of patients with iodine-negative forms of differentiated thyroid cancer, still remains insufficiently studied and requires further scientific and clinical development. Purpose – develop a technique of treatment of iodine-negative metastases of differentiated thyroid cancer. Materials and methods. Thirty-eight patients with iodine-negative metastases of differentiated thyroid cancer were provided with treatment, where in 10 patients the efficiency of treatment was assessed by means of whole body scintigraphy with 99mTc-MIBI, in 10 patients – with 99mTcDMCA. In 10 patients the short-term results of treatment with tyrosine kinase inhibitors were evaluated by PET with 18F-FDG. Eight patients represented a group where the bones were affected and treatment was provided by means of radionuclide or external-beam radiotherapy. The average age of patients varied from 43 to 76, the median was 57.8 + 3.9; out of those: 24 women, 14 men. Pathohistologically, papillary cancer was diagnosed in 31, follicular – in 5, papillary-follicular – in 2. The studies were performed by means of the two-detector gamma camera manufactured by Mediso (Hungary) and the single-photon emission computed tomography (SPECT) E. CAM 180, Siemens (Germany). PET/CT were performed on the Biograph-64-TruePoint-Siemens combined tomograph (Germany), according to the guidelines of the European Association of Nuclear Physicians. Results. Prior to initiating therapy, 10 patients with differentiated thyroid cancer underwent whole body scintigraphy with 99mTc-MIBI and re-examination in three months in order to assess treatment success. After diagnostic examination, the patient was prescribed targeted therapy with Nexavar according to the treatment protocol. Regression of the focus in the lungs was achieved within 70 %. Further monitoring of antitumor treatment success was performed by means of whole body scintigraphy with 99mTc-MIBI. Ten patients, who had PET/CT with 18F-FDG made before treatment, also underwent targeted therapy by means of Nexavar. Diagnostic scanning with 18F-FDG after therapy revealed decreased functional activity of the lesion in the neck, however no decrease in the dimensions of the lesion was observed. Conclusions. Treatment of iodine-negative metastases of differentiated thyroid cancer by means of tyrosine kinase inhibitors was accompanied by a decreasing number of metastatic foci and reducing level of their functional activity. The studies have confirmed the possibility of applying techniques with non-iodine RP (99mTc-MIBI, 99mTc-DMCA) to assess the effectiveness of treatment of iodine-negative metastases of differentiated thyroid cancer . PET/CT with 18F-FDG is a highly informative technique for assessing the effect of tyrosine kinase inhibitors on the functional activity of metastatic foci according to metabolic scans in treatment of iodine-negative metastases of differentiated thyroid cancer. If there are no positive changes after 3–4 courses, external-beam radiotherapy with total radiation dose of 30–50 Gy is indicated, which is capable of reducing the volume of metastatic foci as well as their metabolic activity. The social and economic significance of the obtained findings have made it possible to improve the overall and recurrence-free survival rates in the working population of patients with differentiated thyroid cancer and reduce the cost of following-up patients with iodine-negative forms of differentiated thyroid cancer.

scholarly journals 18F-FDG Pet-Guided External Beam Radiotherapy in Iodine-Refractory Differentiated Thyroid Cancer: A Pilot Study

2017 ◽  
Vol 2017 ◽  
pp. 1-9
Author(s):  
Eleonora Farina ◽  
Fabio Monari ◽  
Paolo Castellucci ◽  
Fabrizio Romani ◽  
Andrea Repaci ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Fdg Pet ◽  
Differentiated Thyroid Cancer ◽  
Response Rate ◽  
External Beam Radiotherapy ◽  
Radiotherapy Planning ◽  
Whole Body ◽  
External Beam ◽  
Pet Ct ◽  
Fdg Pet Ct

Introduction. To evaluate the clinical response rate after a postoperative 18F-FDG PET/CT guided external beam radiotherapy (EBRT) in Iodine-refractory differentiated thyroid cancer. Material and Methods. Patients with thyroid cancer locally recurrent after total thyroidectomy plus metabolic radiotherapy and treated with radical EBRT were included. Inclusion criteria were detectable thyroglobulin (Tg), negative postmetabolic radiotherapy whole body scintigraphy, and no surgical indications. The pretreatment 18F-FDG PET/CT resulted positive in all cases (loggia, lymph nodes, and lung). EBRT was delivered with IMRT-SIB technique. A 18F-FDG PET/CT revaluation and Tg dosage were performed 3 months after the treatment. Results. Sixteen consecutive patients were included in this analysis (median follow-up: 6–44 months). Post-EBRT 18F-FDG PET/CT showed CR in 43.7%, PR in 31.2%, SD in 25.0% patients, and PD due to lung metastases in 12.5%. Overall response rate was 75.0% (CI 95%: 41.4–93.3%). Tg levels decreased in 75.0% with a median Δ of 68.0%. Two-year PFS and OS rates were 80.0% and 93.0%, respectively. Acute G3 toxicity occurred in 18.7% and late G2 toxicity in 12.5%. Conclusions.  18F-FDG PET/CT was useful in target definition for radiotherapy planning, identifying positive areas not detected with 131I scintigraphy. IMRT based EBRT was feasible and our results encourage future prospective studies. This clinical trial is registered with ID: NCT03191643.

scholarly journals The Value of 18F-FDG PET/CT in avoiding overtreatment of 131l Avidity Pulmonary Metastasis of Differentiated Thyroid Cancer

2020 ◽  
Author(s):  
Zhongyun Xu ◽  
Chao Li ◽  
Feng Fang ◽  
Linlin Zhang ◽  
Hui Wang ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Fdg Pet ◽  
Poor Prognosis ◽  
Differentiated Thyroid Cancer ◽  
Tumour Size ◽  
Whole Body ◽  
Fdg Uptake ◽  
Pet Ct ◽  
Fdg Pet Ct ◽  
To Receive

Abstract Background: We usually use 131 I whole body scan and serum thyroglobulin (Tg) values to determine whether differentiated thyroid cancer (DTC) patients need to receive 131 I treatment, but not all 131 I-avid (functioning) patients have good responses, which is more likely to cause the 131 I-avid patient to receive overtreatment. Our study aims to assess the date of 18 F-FDG PET/CT to avoid 131 I overtreatment and research the status of 131 I-avid pulmonary metastases (PMs) and the prognosis of the patients. Methods: The 131 I-avid PMs of DTC patients who underwent 18 F-FDG PET/CT scans were included. The SUVmax (maximum standardized uptake value), MTV (metabolic tumour volume) and TLG (total lesion glycolysis) were used to estimate 18 F-FDG uptake. The mean follow-up period was 34.14 ± 18.64months. Progression-free survival (PFS) was estimated by the Kaplan-Meier method.The study was based on per-patient and per-lesion analyses. Results: Among the 42 included patients, 34 (34/42, 81%) showed 18 F-FDG uptake, which was defined as abnormal foci (SUVmax >1.0) in the lungs. SUVmax, MTV and TLG and tumour size were the factors that influenced the outcome of 131 I treatment based on Tg levels (p=0.000,0.016,0.000,0.000). The only independent factor was the size of the lesion. There was a significant difference in response to 131 I therapy between PMs with F-I+ and F+/I+ according to both Tg levels and RECIST (version 1.1) (p= 0.044,0.001), according to the per-lesion analysis. When the changes in size or metabolism of some lesions are inconsistent with therapeutic efficacy of patients, it indicates that these patients have a poor prognosis (P=0.003). Conclusions: We concluded that higher 18 F-FDG uptake and larger tumour size predict poor therapeutic effects and a high risk of disease progression in 131 I-avid PMs of DTC. For evaluating the efficiency of 131 I treatment, per-lesion analyses and assessing the data of 18 F-FDG PET/CT would be more reliable than per-patient evaluation only. The increasing 18 F-FDG uptake or diameter of PMs may lead to a poor prognosis for the patient, and early focal treatment modalities may improve their life span.

scholarly journals RADIOISOTOPE DIAGNOSTIC ALGORITHM FOR THE RELAPSE AND METASTASES DETECTION IN THE IODINE-NEGATIVE DIFFERENTIATED THYROID CANCER

2020 ◽  
Vol 25 ◽  
pp. 579-591
Author(s):  
O. Solodyannikova ◽  
◽  
Y. Kmetyuk ◽  
V. Danilenko ◽  
G. Sukach ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Ct Scan ◽  
Surgical Management ◽  
Differentiated Thyroid Cancer ◽  
Whole Body ◽  
Technetium 99M ◽  
99Mtc Pertechnetate ◽  
18Fdg Pet ◽  
Pet Ct ◽  
99Mtc Mibi

Objective. Developing of algorithm for the post-surgical management of patients with iodine-negative metastases of differentiated thyroid cancer (DTC). Materials and methods. The DTC patients with iodine-negative metastases (n = 115) were enrolled in the study. Of them the whole body scintigraphy (WBS) was performed with technetium-99m-hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) (n = 30), WBS with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) (n = 30), 18FDG PET (n = 30), and computer tomography (CT-scan) (n = 25). Complex 99mTc-pertechnetate scans including the dynamic and static scintigraphy was performed supplementary to 99mTc-MIBI WBS in 10 patients to obtain the angiographic curves from DTC metastatic foci. The non-radioiodine radiopharmaceutical technologies, namely the labeled 99mTc-MIBI, 99mTc-DMSA, 99mTc-pertechnetate, and 18FDG were applied to detect the iodine-negative DTC metastases. Radioisotopic examinations were performed at the dual-head gamma camera (Mediso Medical Imaging Systems Ltd., Hungary) and single photonemission computed tomography (SPECT) scanner «E.CAM» (Siemens, Germany). PET/CT scans were performed on the «Biograph 64 TruePoint» imaging platform (Siemens, Germany) in accordance with the European Association of Nuclear Medicine (EANM) recommendations for the Siemens imaging devices with 3D-mode data acquisition. Results. The conducted research suggested that it is feasible to use the non-radioiodine (99mTc-MIBI and 99mTc-DMSA) radiopharmaceutical technologies to detect the iodine-negative DTC metastases. 18FDG PET is a highly informative technology for the detection of iodine-negative DTC metastases in case of lung involvement in the process. Compare of the non-radioiodine radiopharmaceuticals, CT scan and 18FDG-PET/CT indicated the highest sensitivity of 18FDG PET/CT (p < 0.05). WBS with 99mTc-MIBI and 99mTc-DMSA featured the highest specificity (100 %, p < 0.05). X-ray CT is marked by the significantly lower either sensitivity, specificity, and accuracy rate (p > 0.05). Developing and application of algorithm for the post-surgical management of patients with iodine-negative forms of DTC will allow for the betimes detection of relapses and metastases with administration of adequate surgical, radiation, and targeted treatment. Conclusions. Obtained results offer the opportunity to optimize the post-surgical management of patients with iodine-negative DTC forms using the options of radionuclide diagnostics with non-radioiodine radiopharmaceuticals. The latter are readily available providing the cost-cutting of diagnostic support in these patients. Place of morphological methods of diagnosis is determined and stage of monitoring of patients with the iodine-negative metastases is established. Possibility of the 18FDG-PET tests for the early diagnosis of iodine-negative metastases in DTC for the first time have been studied and substantiated in Ukraine. A comprehensive radiation algorithm for the long-term monitoring of this category of patients will allow the timely detection of recurrences and metastases of DTC and appropriate surgery, radiation and targeted therapy administration. Data obtained as a result of the study allowed to improve the overall and recurrence-free survival rates in the able-bodied DTC patients and reduce the costs of follow-up of patients with iodine-negative forms of DTC. Key words: differentiated thyroid cancer, radioiodine-negative metastases, non-radioiodine radiopharmaceuticals, 18FDG-PET/CT.

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