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Effectiveness of [(124)I]-PET/CT and [(18)F]-FDG-PET/CT for localizing recurrence in patients with differentiated thyroid carcinoma

Authors
Lee, J; Nah, KY; Kim, RM; Oh, YJ; An, YS; Yoon, JK; An, GI; Choi, TH; Cheon, GJ; Soh, EY; Chung, WY
Citation
Journal of Korean medical science, 27(9):1019-1026, 2012
Journal Title
Journal of Korean medical science
ISSN
1011-89341598-6357
Abstract
Although the prognosis of patients with differentiated thyroid carcinoma (DTC) is generally encouraging, a diagnostic dilemma is posed when an increasing level of serum thyroglobulin (Tg) is noted, without detection of a recurrent tumor using conventional imaging tools such as the iodine-131 whole-body scanning (the [(131)I] scan) or neck ultrasonography (US). The objective of the present study was to evaluate the diagnostic value of [(124)I]-PET/CT and [(18)F]-FDG-PET/CT in terms of accurate detection of both iodine- and non-iodine-avid recurrence, compared with that of conventional imaging such as the [(131)I] scan or neck ultrasonography (US). Between July 2009 and June 2010, we prospectively studied 19 DTC patients with elevated thyroglobulin levels but who do not show pathological lesions when conventional imaging modalities are used. All involved patients had undergone total thyroidectomy and radioiodine (RI) treatment, and who had been followed-up for a mean of 13 months (range, 6-21 months) after the last RI session. Combined [(18)F]-FDG-PET/CT and [(124)I]-PET/CT data were evaluated for detecting recurrent DTC lesions in study patients and compared with those of other radiological and/or cytological investigations. Nine of 19 patients (47.4%) showed pathological [(18)F]-FDG (5/19, 26.3%) or [(124)I]-PET (4/19, 21.1%) uptake, and were classed as true-positives. Among such patients, disease management was modified in six (66.7%) and disease was restaged in seven (77.8%). In particular, the use of the described imaging combination optimized planning of surgical resection to deal with locoregional recurrence in 21.1% (4/19) of patients, who were shown to be disease-free during follow-up after surgery. Our results indicate that combination of [(18)F]-FDG-PET/CT and [(124)I]-PET/CT affords a valuable diagnostic method that can be used to make therapeutic decisions in patients with DTC who are tumor-free on conventional imaging studies but who have high Tg levels.
MeSH terms
AdultAgedAged, 80 and overCarcinoma/metabolism/*radionuclide imaging/surgeryFemaleFluorodeoxyglucose F18/chemistry/diagnostic useFollow-Up StudiesHumansIodine Radioisotopes/chemistry/diagnostic useMaleMiddle AgedNeck/ultrasonographyPositron-Emission Tomography and Computed TomographyProspective StudiesRadiopharmaceuticals/chemistry/*diagnostic useRecurrenceThyroglobulin/bloodThyroid Neoplasms/metabolism/*radionuclide imaging/surgeryThyroidectomyWhole Body Imaging
DOI
10.3346/jkms.2012.27.9.1019
PMID
22969247
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Journal Papers > School of Medicine / Graduate School of Medicine > Nuclear Medicine & Molecular Imaging
AJOU Authors
안, 영실윤, 준기소, 의영
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