Original Articles

European Journal of Nuclear Medicine and Molecular Imaging

, Volume 31, Issue 10, pp 1435-1442

First online:

Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma

  • K. TharpAffiliated withVanderbilt University Medical Center
  • , O. IsraelAffiliated withRambam Medical Center, School of Medicine, Technion
  • , J. HausmannAffiliated withVanderbilt University Medical Center
  • , L. BettmanAffiliated withRambam Medical Center, School of Medicine, Technion
  • , W. H. MartinAffiliated withVanderbilt University Medical Center
  • , M. DaitzchmanAffiliated withRambam Medical Center, School of Medicine, Technion
  • , M. P. SandlerAffiliated withVanderbilt University Medical Center
  • , D. DelbekeAffiliated withVanderbilt University Medical Center Email author 

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Abstract

Purpose

The purpose of the study was to determine the diagnostic impact of 131I-SPECT/CT imaging compared with conventional scintigraphic evaluation in the follow-up of patients with thyroid carcinoma.

Methods

Seventy-one patients with thyroid carcinoma underwent concurrent 131I-SPECT/CT, using an integrated imaging system, at various stages of their disease in order to evaluate foci of uptake detected on planar whole-body images.

Results

SPECT/CT imaging had an incremental diagnostic value in 57% (41/71) of patients. Uptake in the neck was evaluated in 61 patients, and SPECT/CT imaging in this region had an incremental diagnostic value in 27% of the whole patient population (19/71). Low-resolution integrated CT images allowed for the precise characterization of equivocal neck lesions on planar imaging in 14/17 patients and changed the assessment of the lesion location in five patients as compared with planar studies. Thirty-six patients underwent SPECT/CT for evaluation of foci of uptake distant from the neck. SPECT/CT imaging improved characterization of equivocal foci of uptake as definitely benign in 13% (9/71) of patients. Precise localization of malignant lesions to the skeleton was possible in 17% (12/71) and to the lungs versus the mediastinum in 6% (5/71) of patients.

Conclusion

Integrated 131I-SPECT/CT was found to have an additional value over planar imaging in patients with thyroid cancer for correct characterization of equivocal tracer uptake seen on planar imaging as well as for precise localization of malignant lesions in the neck, chest, and skeleton. SPECT/CT optimized the localization of 131I uptake to lymph node metastases versus remnant thyroid tissue, to lung versus mediastinal metastases, and to the skeleton. It also had a further clinical impact on patient management by influencing referral for 131I treatment, tailoring of the administered radioiodine dose, and/or the addition of surgery or external radiation therapy when indicated.

Keywords

Image fusion Emission computed tomography SPECT/CT Radioactive iodine Thyroid cancer