ENDOCRINOLOGY - I
Diagnostic procedures 

The Quarterly Journal of Nuclear Medicine 1999 September;43(3):195-206

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Non-131I-scintigraphy in the treatment and follow-up of thyroid cancer. Single-photon-emitters or FDG-PET?

Grunwald F., Briele B.*, Biersack H. J.

From the Department of Nuclear Medicine University of Bonn, Germany and * Department of Radiology Municipal Hospital of Fulda, Germany

With ­respect to fur­ther ther­a­peu­tic ­options, ­whole-­body 131I scin­tig­ra­phy (WBS) is the ­most impor­tant func­tion­al imag­ing tech­nique dur­ing treat­ment and fol­low-up of dif­fer­en­tiat­ed thy­roid can­cer. But in ­many ­patients, thy­roid can­cer tis­sue ­does not con­cen­trate 131I and can there­fore not be local­ized ­using WBS. In addi­tion to mor­pho­log­ic tech­niques, ­which ­have a low spec­i­fic­ity in ­many cas­es, oth­er meth­ods are nec­es­sary to local­ize ­tumor tis­sue in ­these ­patients. Besides 201Tl, ­which has ­been ­used initial­ly as a ­tumor-seek­ing ­agent, ses­ta­mi­bi, tet­ro­fos­min and 18F-DG for PET imag­ing ­have ­been eval­u­at­ed in dif­fer­en­tiat­ed thy­roid car­ci­no­ma. This ­paper sum­mariz­es the clin­i­cal ­impact of func­tion­al imag­ing ­with trac­ers ­besides 131I. In ­direct com­par­i­son, 18F-DG-PET has the high­est sen­si­tiv­ity, ­which ­exceeds 80% in cas­es ­with neg­a­tive WBS. If avail­able, ­this meth­od ­should be con­sid­ered in all ­patients suf­fer­ing ­from dif­fer­en­tiat­ed thy­roid can­cer ­with sus­pect­ed recur­rence and/or metas­ta­ses, par­tic­u­lar­ly in cas­es ­with ele­vat­ed thy­ro­glob­u­lin val­ues and neg­a­tive WBS. But ­also 99mTc-­labeled trac­ers can be ­used to ­detect ­tumor tis­sue ­with a suf­fi­cient sen­si­tiv­ity. In medul­lary thy­roid can­cer, ­which ­presents fre­quent­ly ­with diag­nos­tic dif­fi­cul­ties, 111In-octre­o­tide, 99mTc-(V)-­DMSA, 131I/123I-mIBG, and ­anti-CEA can be ­used, in addi­tion.