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Chandekar KR, Satapathy S, Bal C. Positron Emission Tomography/Computed Tomography in Thyroid Cancer: An Updated Review. PET Clin 2024; 19:131-145. [PMID: 38212213 DOI: 10.1016/j.cpet.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
PET/computed tomography (CT) is a valuable hybrid imaging modality for the evaluation of thyroid cancer, potentially impacting management decisions. 18F-fluorodeoxyglucose (FDG) PET/CT has proven utility for recurrence evaluation in differentiated thyroid cancer (DTC) patients having thyroglobulin elevation with negative iodine scintigraphy. Aggressive histologic subtypes such as anaplastic thyroid cancer shower higher FDG uptake. 18F-FDOPA is the preferred PET tracer for medullary thyroid cancer. Fibroblast activation protein inhibitor and arginylglycylaspartic acid -based radiotracers have emerged as promising PET agents for radioiodine refractory DTC patients with the potential for theranostic application.
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Abstract
PURPOSE OF REVIEW Thyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment. RECENT FINDINGS To achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE. SUMMARY Multidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.
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Affiliation(s)
- Molly E. Roseland
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Division of Body Imaging, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Yuni K. Dewaraja
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Ka Kit Wong
- Division of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Wang H, Dai H, Li Q, Shen G, Shi L, Tian R. Investigating 18F-FDG PET/CT Parameters as Prognostic Markers for Differentiated Thyroid Cancer: A Systematic Review. Front Oncol 2021; 11:648658. [PMID: 34055616 PMCID: PMC8158293 DOI: 10.3389/fonc.2021.648658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/16/2021] [Indexed: 02/05/2023] Open
Abstract
Aims: The aim of this study was to determine whether 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) parameters might be prognostic markers for patients with differentiated thyroid carcinoma (DTC). Methods: We searched for eligible articles in PubMed, EMBASE (Ovid), Cochrane Library, and ClinicalTrials.gov from inception to February 2021. We included studies addressing the association between 18F-FDG PET/CT parameters and clinical outcomes among patients with DTC. Quality assessment was performed using the Quality in Prognosis Studies (QUIPS) tool. Results: A total of 25 studies including 2,954 patients (1,994 females, 67.5%) were included; 2,416 patients (81.8%) had papillary thyroid carcinoma (PTC), and the mean or median follow-up time ranged from 19.1 months to 17.1 years. Thirteen (52.0%) studies were assessed as “unclear” for the domain of study participation. The most common timing of PET/CT scans was after thyroidectomy (in 20 of 25 studies, 80%), especially in patients with an elevated thyroglobulin (Tg) and a negative radioiodine whole-body scan (WBS). The most common PET parameter was FDG uptake. Twelve of 17 (70.6%) and 12 of 12 (100%) studies showed an association between PET/CT parameters and disease progression and survival in patients with DTC, respectively. Conclusion:18F-FDG PET/CT parameters alone or combined with other variables can serve as prognostic markers to identify DTC patients with poor outcomes, especially in the setting of an elevated Tg and a negative WBS. Future research is needed to confirm these findings and to examine the prognostic value of PET/CT parameters for DTC patients, considering the heterogeneity in PET/CT parameters, unclear information of patients, and PET/CT-adapted treatment modifications.
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Affiliation(s)
- Hongxi Wang
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyuan Dai
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qianrui Li
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Guohua Shen
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Shi
- Department of Nuclear Medicine, Chengdu Fifth People's Hospital, Chengdu, China
| | - Rong Tian
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China
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Nervo A, Ragni A, Retta F, Gallo M, Piovesan A, Liberini V, Gatti M, Ricardi U, Deandreis D, Arvat E. Bone metastases from differentiated thyroid carcinoma: current knowledge and open issues. J Endocrinol Invest 2021; 44:403-419. [PMID: 32743746 PMCID: PMC7878269 DOI: 10.1007/s40618-020-01374-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/24/2020] [Indexed: 12/11/2022]
Abstract
Bone represents the second most common site of distant metastases in differentiated thyroid cancer (DTC). The clinical course of DTC patients with bone metastases (BM) is quite heterogeneous, but generally associated with low survival rates. Skeletal-related events might be a serious complication of BM, resulting in high morbidity and impaired quality of life. To achieve disease control and symptoms relief, multimodal treatment is generally required: radioiodine therapy, local procedures-including surgery, radiotherapy and percutaneous techniques-and systemic therapies, such as kinase inhibitors and antiresorptive drugs. The management of DTC with BM is challenging: a careful evaluation and a personalized approach are essential to improve patients' outcomes. To date, prospective studies focusing on the main clinical aspects of DTC with BM are scarce; available analyses mainly include cohorts assembled over multiple decades, small samples sizes and data about BM not always separated from those regarding other distant metastases. The aim of this review is to summarize the most recent evidences and the unsolved questions regarding BM in DTC, analyzing several key issues: pathophysiology, prognostic factors, role of anatomic and functional imaging, and clinical management.
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Affiliation(s)
- A. Nervo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - A. Ragni
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - F. Retta
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - M. Gallo
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - A. Piovesan
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - V. Liberini
- Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - M. Gatti
- Radiology Unit, Department of Surgical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - U. Ricardi
- Radiation Oncology, Department of Oncology, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - D. Deandreis
- Nuclear Medicine, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - E. Arvat
- Oncological Endocrinology Unit, Department of Medical Sciences, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
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Su DH, Chang TC, Chang SH. Prognostic factors on outcomes of follicular thyroid cancer. J Formos Med Assoc 2019; 118:1144-1153. [DOI: 10.1016/j.jfma.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 10/30/2018] [Accepted: 11/15/2018] [Indexed: 02/02/2023] Open
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Stecco A, Trisoglio A, Soligo E, Berardo S, Sukhovei L, Carriero A. Whole-Body MRI with Diffusion-Weighted Imaging in Bone Metastases: A Narrative Review. Diagnostics (Basel) 2018; 8:diagnostics8030045. [PMID: 29987207 PMCID: PMC6163267 DOI: 10.3390/diagnostics8030045] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/29/2018] [Accepted: 07/04/2018] [Indexed: 12/12/2022] Open
Abstract
Whole body magnetic resonance imaging (MRI) with diffusion-weighted imaging (WB-MRI-DWI) is currently emerging as a diagnostic technique in the evaluation of bone metastases from breast, prostate, lung, thyroid, and melanoma tumors. The most relevant articles regarding the detection of solid tumor bone metastases with MRI have been reviewed and cited. The imaging methods currently used in the detection of bone metastases are bone scintigraphy, computed tomography (CT), and positron emission tomography (PET/CT) with 2-deoxy-2-[fluorine-18] fluoro-d-glucose (18F-FDG PET/CT). WB-MRI-DWI allows qualitative and quantitative evaluation of focal lesions through signal intensity evaluation on DWI images and the reconstruction of the apparent diffusion coefficient (ADC) map. In prostate and breast cancer, WB-MRI-DWI is useful in assessing the response of bone lesions to therapy and to detecting early non-responders, while in lung cancer the method shows a similar sensitivity to 18F-FDG PET/CT in the detection of bone metastases. In bone metastases of thyroid tumors and melanoma, the WB-MRI-DWI shows a higher sensitivity when compared to 18F-FDG PET/CT. With a standardization of the WB-MRI-DWI protocol, this method seems to play an important role in the diagnosis of bone solid tumor metastases.
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Affiliation(s)
- Alessandro Stecco
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Alessandra Trisoglio
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Eleonora Soligo
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Sara Berardo
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Lidiia Sukhovei
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
| | - Alessandro Carriero
- Ospedale Maggiore della Carità di Novara, Istituto di Radiodiagnostica ed Interventistica, Università del Piemonte Orientale, Amedeo Avogadro, Corso Giuseppe Mazzini 18, 28100 Novara, Italy.
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Schütz F, Lautenschläger C, Lorenz K, Haerting J. Positron Emission Tomography (PET) and PET/CT in Thyroid Cancer: A Systematic Review and Meta-Analysis. Eur Thyroid J 2018; 7:13-20. [PMID: 29594049 PMCID: PMC5836193 DOI: 10.1159/000481707] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Positron emission tomography (PET) and PET/CT are functional imaging methods that are widely used in diagnostic procedures in oncology. OBJECTIVES The objective of this study was to assess the patient-relevant benefit of PET or PET/CT in patients with thyroid cancer based on a literature review and meta-analysis. METHODS A systematic review including studies that had been published until December 2013 was performed. To be included, studies had to prospectively investigate patients with thyroid cancer in a clinical setting of staging, restaging, or diagnosing tumour recurrence. RESULTS Out of 3,506 potentially relevant articles, 29 studies were included. No study directly evaluated the benefits of PET. Twenty-eight studies dealt with the diagnostic accuracy of PET or PET/CT, and 1 study evaluated the prognostic value of PET/CT. The authors showed that a positive result of PET/CT in restaging patients with differentiated thyroid cancer yielded a significant decrease in overall survival (hazard ratio, HR 5.01, CI 3.41-6.62). In patients with suspected recurrence of differentiated thyroid cancer, meta-analysis showed higher sensitivity of PET (89.7%, CI 78-99%) and PET/CT (94.3%, CI 87-97%) compared with conventional imaging (65.4%, CI 32-88%) and comparable results for specificity. Due to the low numbers of studies and patients, meta-analyses on medullary carcinoma did not produce meaningful results. CONCLUSION The patient-relevant benefits of PET or PET/CT in thyroid cancer could not be evaluated satisfactorily based on the included studies. It remains unclear whether higher diagnostic test accuracy leads to changes in therapeutic strategies and better patient-relevant outcomes.
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Affiliation(s)
- Friederike Schütz
- Martin Luther University Halle-Wittenberg, Institute for Medical Epidemiology, Biostatistics and Informatics, Halle (Saale), Germany
| | - Christine Lautenschläger
- Martin Luther University Halle-Wittenberg, Institute for Medical Epidemiology, Biostatistics and Informatics, Halle (Saale), Germany
| | - Kerstin Lorenz
- Department of General, Visceral and Vascular Surgery, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Johannes Haerting
- Martin Luther University Halle-Wittenberg, Institute for Medical Epidemiology, Biostatistics and Informatics, Halle (Saale), Germany
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Hempel JM, Kloeckner R, Krick S, Pinto Dos Santos D, Schadmand-Fischer S, Boeßert P, Bisdas S, Weber MM, Fottner C, Musholt TJ, Schreckenberger M, Miederer M. Impact of combined FDG-PET/CT and MRI on the detection of local recurrence and nodal metastases in thyroid cancer. Cancer Imaging 2016; 16:37. [PMID: 27809936 PMCID: PMC5093960 DOI: 10.1186/s40644-016-0096-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 10/25/2016] [Indexed: 12/19/2022] Open
Abstract
Background Suspected recurrence of thyroid carcinoma is a diagnostic challenge when findings of both a radio iodine whole body scan and ultrasound are negative. PET/CT and MRI have shown to be feasible for detection of recurrent disease. However, the added value of a consensus reading by the radiologist and the nuclear medicine physician, which has been deemed to be helpful in clinical routines, has not been investigated. This study aimed to investigate the impact of combined FDG-PET/ldCT and MRI on detection of locally recurrent TC and nodal metastases in high-risk patients with special focus on the value of the multidisciplinary consensus reading. Materials and methods Forty-six patients with suspected locally recurrent thyroid cancer or nodal metastases after thyroidectomy and radio-iodine therapy were retrospectively selected for analysis. Inclusion criteria comprised elevated thyroglobulin blood levels, a negative ultrasound, negative iodine whole body scan, as well as combined FDG-PET/ldCT and MRI examinations. Neck compartments in FDG-PET/ldCT and MRI examinations were independently analyzed by two blinded observers for local recurrence and nodal metastases of thyroid cancer. Consecutively, the scans were read in consensus. To explore a possible synergistic effect, FDG-PET/ldCT and MRI results were combined. Histopathology or long-term follow-up served as a gold standard. For method comparison, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated. Results FDG-PET/ldCT was substantially more sensitive and more specific than MRI in detection of both local recurrence and nodal metastases. Inter-observer agreement was substantial both for local recurrence (κ = 0.71) and nodal metastasis (κ = 0.63) detection in FDG-PET/ldCT. For MRI, inter-observer agreement was substantial for local recurrence (κ = 0.69) and moderate for nodal metastasis (κ = 0.55) detection. In contrast, FDG-PET/ldCT and MRI showed only slight agreement (κ = 0.21). However, both imaging modalities identified different true positive results. Thus, the combination created a synergistic effect. The multidisciplinary consensus reading further increased sensitivity, specificity, and diagnostic accuracy. Conclusions FDG-PET/ldCT and MRI are complementary imaging modalities and should be combined to improve detection of local recurrence and nodal metastases of thyroid cancer in high-risk patients. The multidisciplinary consensus reading is a key element in the diagnostic approach. Electronic supplementary material The online version of this article (doi:10.1186/s40644-016-0096-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johann-Martin Hempel
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany. .,Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany.
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Sandra Krick
- Department of Nuclear Medicine, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Daniel Pinto Dos Santos
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Simin Schadmand-Fischer
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Patrick Boeßert
- Department of Otolaryngology and Head and Neck Surgery, AMEOS Hospital Haldensleben, Kiefholzstr. 4 & 27, D-39340, Haldensleben, Germany
| | - Sotirios Bisdas
- Department of Radiology, Diagnostic and Interventional Neuroradiology, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, D-72076, Tübingen, Germany.,Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, University College London Hospitals, London, United Kingdom
| | - Matthias M Weber
- Department of Endocrinology and Metabolism, I. Medical Clinic, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Christian Fottner
- Department of Endocrinology and Metabolism, I. Medical Clinic, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Thomas J Musholt
- Clinic of General, Visceral- and Transplantation Surgery, Endocrine Surgery Section, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Mathias Schreckenberger
- Department of Nuclear Medicine, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
| | - Matthias Miederer
- Department of Nuclear Medicine, Johannes Gutenberg-University Medical Center, Langenbeckstr. 1, D-55131, Mainz, Germany
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Treglia G, Giovanella L. Prognostic role of FDG-PET/CT in differentiated thyroid carcinoma: Where are we now? J Med Imaging Radiat Oncol 2016; 59:278-80. [PMID: 26053477 DOI: 10.1111/1754-9485.12317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 04/11/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Giorgio Treglia
- Department of Nuclear Medicine, Thyroid and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luca Giovanella
- Department of Nuclear Medicine, Thyroid and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Isoda T, BaBa S, Maruoka Y, Kitamura Y, Tahara K, Sasaki M, Honda H. Impact of patient age on the iodine/FDG "flip-flop" phenomenon in lung metastasis from thyroid cancer. Ann Nucl Med 2016; 30:518-24. [PMID: 27380042 DOI: 10.1007/s12149-016-1104-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 05/22/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Radioiodine therapy is an effective treatment for lung metastasis from thyroid cancer. However, cases of lung metastasis without iodine uptake are often encountered. In such cases, FDG accumulation in lung lesions is often observed. There is a reverse relationship between iodine and FDG accumulation in thyroid cancer lesions, the so-called "flip-flop" phenomenon. The aim of this study was to assess the relationship between patient age and the occurrence of the flip-flop phenomenon. METHODS Eighty-six patients who underwent radioiodine therapy for lung metastasis were studied retrospectively (age 17-73 years; median 60 years; males:females 22:64). We compared the clinical data and imaging findings (size and FDG uptake of lung nodules) between patients with (n = 44) and without (n = 42) iodine uptake in lung metastasis. RESULTS Significantly more young patients showed iodine accumulation in lung metastasis than old patients (p = 0.0025). Lung metastases with larger size or greater FDG uptake showed no iodine uptake more frequently with significant difference (p = 0.015 and <0.001, respectively). Among patients with FDG uptake in the lung metastasis, 57.1 % of young patients (<60 years) and 24.3 % of the old patients (≥60 years) showed iodine uptake (p = 0.0029). CONCLUSIONS Higher patient age and lung nodules with large size or FDG accumulation are negative factors for iodine accumulation in lung metastases from thyroid cancer. In addition, our results show that young patients have a greater likelihood of iodine uptake even when FDG accumulates in lung metastasis, in contrast to old patients.
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Affiliation(s)
- Takuro Isoda
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan.
| | - Shingo BaBa
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Yasuhiro Maruoka
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Yoshiyuki Kitamura
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Keiichiro Tahara
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-Ku Fukuoka, Fukuoka, 812-8582, Japan
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Tsuruda T, Nagamachi S, Nishimura M, Nakamura K, Kitamura K. Multiple 18F-Fluorodeoxyglucose Positron Emission Tomography Scans Showing Progression of Abdominal Aortic Aneurysm: A Case Report. Medicine (Baltimore) 2016; 95:e3650. [PMID: 27175690 PMCID: PMC4902532 DOI: 10.1097/md.0000000000003650] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although the precise mechanisms underlying the pathogenesis of abdominal aortic aneurysm (AAA) remain unclear, aortic wall inflammation has been implicated in AAA development. Several studies have reported the use of fluoro-deoxyglucose (F-FDG)/positron emission tomography (PET) to assess the nature of AAA.We present a case of 77-year-old Japanese male with juxta-anastomotic AAA who was followed up with multiple F-FDG-PET/CT scans over 7 years. The scans revealed chronological changes in aortic wall inflammation leading to progress and eventual rupture.This case supports a notion that aortic wall inflammation plays a role in AAA progression and rupture.
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Affiliation(s)
- Toshihiro Tsuruda
- From the Departments of Internal Medicine, Circulatory and Body Fluid Regulation (TT, KK); Cardiovascular, Thoracic and General Surgery (MN, KN), Faculty of Medicine, University of Miyazaki, Miyazaki, Japan; and Radiological Division (SN), University of Miyazaki Hospital, Miyazaki, Japan
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[(68)Ga]DOTATATE PET/MRI and [(18)F]FDG PET/CT are complementary and superior to diffusion-weighted MR imaging for radioactive-iodine-refractory differentiated thyroid cancer. Eur J Nucl Med Mol Imaging 2016; 43:1765-72. [PMID: 27059853 DOI: 10.1007/s00259-016-3378-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 03/22/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE The purpose of this study was to determine whether [(68)Ga]DOTATATE PET/MRI with diffusion-weighted imaging (DWI) can replace or complement [(18)F]FDG PET/CT in patients with radioactive-iodine (RAI)-refractory differentiated thyroid cancer (DTC). METHODS The study population comprised 12 patients with elevated thyroglobulin and a negative RAI scan after thyroidectomy and RAI remnant ablation who underwent both [(18)F]FDG PET/CT and [(68)Ga]DOTATATE PET/MRI within 8 weeks of each other. The presence of recurrent cancer was evaluated on a per-patient, per-organ and per-lesion basis. Histology, and prior and follow-up examinations served as the standard of reference. RESULTS Recurrent or metastatic tumour was confirmed in 11 of the 12 patients. [(68)Ga]DOTATATE PET(/MRI) correctly identified the tumour burden in all 11 patients, whereas in one patient local relapse was missed by [(18)F]FDG PET/CT. In the lesion-based analysis, overall lesion detection rates were 79/85 (93 %), 69/85 (81 %) and 27/82 (33 %) for [(18)F]FDG PET/CT, [(68)Ga]DOTATATE PET/MRI and DWI, respectively. [(18)F]FDG PET(/CT) was superior to [(68)Ga]DOTATATE PET(/MRI) in the overall evaluation and in the detection of pulmonary metastases. In the detection of extrapulmonary metastases, [(68)Ga]DOTATATE PET(/MRI) showed a higher sensitivity than [(18)F]FDG PET(/CT), at the cost of lower specificity. DWI achieved only poor sensitivity and was significantly inferior to [(18)F]FDG PET in the lesion-based evaluation in the detection of both extrapulmonary and pulmonary metastases. CONCLUSION [(18)F]FDG PET/CT was more sensitive than [(68)Ga]DOTATATE PET/MRI in the evaluation of RAI-refractory DTC, mostly because of its excellent ability to detect lung metastases. In the evaluation of extrapulmonary lesions, [(68)Ga]DOTATATE PET(/MRI) was more sensitive and [(18)F]FDG PET(/CT) more specific. Furthermore, DWI did not provide additional information and cannot replace [(18)F]FDG PET for postoperative monitoring of patients with suspected RAI-refractory DTC.
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Zhang Y, Liu X, Zhang Y, Li WF, Chen L, Mao YP, Shen JX, Zhang F, Peng H, Liu Q, Sun Y, Ma J. Prognostic value of the primary lesion apparent diffusion coefficient (ADC) in nasopharyngeal carcinoma: a retrospective study of 541 cases. Sci Rep 2015; 5:12242. [PMID: 26184509 PMCID: PMC4505330 DOI: 10.1038/srep12242] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/18/2015] [Indexed: 12/15/2022] Open
Abstract
The prognostic value of the primary lesion pretreatment apparent diffusion coefficient (ADC), which is obtained by diffusion-weighted magnetic resonance imaging (MR-DWI), remains unknown in nasopharyngeal carcinoma (NPC). Thus, to investigate whether the pretreatment ADC value as measured from the primary site on MR-DWI is an independent prognostic factor in NPC, we retrospectively reviewed a cohort of 541 patients with histologically-proven stage I-IVB NPC. All patients underwent MRI using a 3-Tesla system (Trio Tim; Siemens, Erlangen Germany). To calculate ADC, the primary lesion was designated on the ADC map at the level of the largest tumor diameter to cover most of the lesion, avoiding cystic or necrotic components. Median and mean (±SD) pretreatment ADC were 0.713 and 0.716 ± 0.079 × 10−3 mm2/s, respectively. Univariate and multivariate analysis confirmed high pretreatment ADC was a good prognostic factor for poor local relapse-free survival and disease-free survival. Furthermore, the area under the ROC curve for prediction of local failure significantly increased when pretreatment ADC was combined with T classification (P = 0.004). Thus, pretreatment ADC might provide useful information for predicting outcome and selecting high-risk patients appropriate for more aggressive therapy. Further studies are warranted to investigate the biological basis of this observation.
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Affiliation(s)
- Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Xu Liu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Yun Zhang
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Wen-Fei Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Jing-Xian Shen
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Fan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Hao Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Qing Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Canton, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Canton, Guangdong Province, People's Republic of China
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Wu LM, Chen XX, Li YL, Hua J, Chen J, Hu J, Xu JR. On the utility of quantitative diffusion-weighted MR imaging as a tool in differentiation between malignant and benign thyroid nodules. Acad Radiol 2014; 21:355-63. [PMID: 24332602 DOI: 10.1016/j.acra.2013.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the ability of diffusion-weighted magnetic resonance imaging (DWI) in differentiating malignant thyroid nodules from benign lesions with a meta-analysis. MATERIALS AND METHODS Articles in English and Chinese language relating to the accuracy of DWI for this utility were retrieved. Pooled estimation and subgroup analysis data were obtained by statistical analysis. RESULTS A total of seven studies (17 subsets) with 358 patients, who fulfilled all of the inclusion criteria, were considered for the analysis. No publication bias was found (bias = 7.03, P > .05). Methodological quality was relatively high. DWI sensitivity was 0.91 (95% confidence interval [CI], 0.87-0.94) and specificity was 0.93 (95% CI, 0.86-0.96). Overall, positive likelihood ratio was 12.24 (95% CI, 6.47-23.20) and negative likelihood ratio was 0.99 (95% CI, 0.06-0.15). Diagnostic odds ratio was 123.78 (95% CI, 56.85-269.48). The area under the curve of the summary receiver operating characteristic was 0.94 (95% CI, 0.92-0.96). In patients with high pretest probabilities, DWI enabled confirmation of malignant thyroid lesion; in patients with low pretest probabilities, DWI enabled exclusion of malignant thyroid lesion. Worst-case-scenario (pretest probability, 50%) posttest probabilities were 92% and 9% for positive and negative DWI results, respectively. CONCLUSIONS A limited number of small studies suggests that quantitative DWI is a reliable diagnostic method for differentiation between benign and malignant thyroid lesions.
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Yu X, Lee EYP, Lai V, Chan Q. Correlation between tissue metabolism and cellularity assessed by standardized uptake value and apparent diffusion coefficient in peritoneal metastasis. J Magn Reson Imaging 2013; 40:99-105. [DOI: 10.1002/jmri.24361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/12/2013] [Indexed: 11/08/2022] Open
Affiliation(s)
- Xue Yu
- Department of Diagnostic Radiology; University of Hong Kong; Hong Kong China
| | | | - Vincent Lai
- Department of Diagnostic Radiology; University of Hong Kong; Hong Kong China
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Treglia G, Bertagna F, Piccardo A, Giovanella L. 131I whole-body scan or 18FDG PET/CT for patients with elevated thyroglobulin and negative ultrasound? Clin Transl Imaging 2013. [DOI: 10.1007/s40336-013-0024-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jin J, Phitayakorn R, Wilhelm SM, McHenry CR. Advances in management of thyroid cancer. Curr Probl Surg 2013; 50:241-89. [DOI: 10.1067/j.cpsurg.2013.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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