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J Clin Endocrinol Metab. 2009 Jun;94(6):2075-84. doi: 10.1210/jc.2008-2313. Epub 2009 Mar 10.

Clinical relevance of single-photon emission computed tomography/computed tomography of the neck and thorax in postablation (131)I scintigraphy for thyroid cancer.

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1
Department of Nuclear Medicine and Thyroid Unit, Centre Fran├žois Baclesse, F-14076 Caen Cedex 05, France.

Abstract

CONTEXT:

In patients with differentiated thyroid carcinoma, postablation (131)I scintigraphy aims to detect residual neck disease and distant metastases, usually found in lungs and bones. New hybrid single-photon emission computed tomography/computed tomography (SPECT-CT) cameras that permit functional and anatomical image fusion may improve its clinical relevance.

OBJECTIVE:

Our objective was to test the added value of neck and thorax SPECT-spiral CT to whole-body scan (WBS) in postablation (131)I scintigraphy.

DESIGN AND SETTING:

This was a single-referral-center prospective study with a median follow-up of 21 months.

PATIENTS AND METHODS:

Postablation (131)I WBS and neck and thorax SPECT-CT were performed in 55 consecutive patients treated in 2006. WBS and SPECT-CT data were blindly reviewed, scored negative (benign), positive (malignant), or indeterminate and were correlated to the patient outcome.

RESULTS:

At patient level, WBS and SPECT-CT were negative in 67 and 78% of patients, positive in 4 and 15%, and indeterminate in 29 and 7%, respectively. Overall, nine patients (16%) presented treatment failure (persistent or recurrent disease) 1-16 months after radioiodine ablation. In the 16 patients with indeterminate WBS, negative SPECT-CT ruled out suspicion of disease in nine of nine patients, and positive SPECT-CT confirmed malignant lesions in four of five patients. Positive SPECT-CT predicted treatment failure better than positive WBS (McNemar's test, P = 0.03).

CONCLUSIONS:

This study demonstrates the complementary role of neck and thorax SPECT-CT to WBS in postablation (131)I scintigraphy. Because SPECT-CT allows one to confirm or to rule out residual disease in most cases where WBS remains indeterminate, we recommend its use when available.

PMID:
19276233
DOI:
10.1210/jc.2008-2313
[Indexed for MEDLINE]

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