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Imaging Modalities in the Diagnosis of Recurrent or Metastatic Thyroid Cancer

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Management of Differentiated Thyroid Cancer

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Abstract

The imaging of thyroid cancer takes a multimodality approach, and this is particularly the case for the workup of recurrent and metastatic disease. Ultrasound can be used to look for regional nodes or evaluate palpable lesions. Cross-sectional imaging such as computed tomography (CT) and magnetic resonance [MR] can look for disease in the neck as well as throughout the body. Total body iodine scans with low-dose 123I or 131I can be used for evaluating residual functioning tissue following total thyroidectomy prior to radioiodine ablation and can also be used to detect nodal and distant metastatic disease in high-risk patients; some iodine-avid metastases may not be visible on CT or MR imaging. In high-risk patients, total body iodine (TBI) scans can help determine the appropriate 131I dose for radioablation. TBI scans can also be used to evaluate patients suspected of having recurrent disease following ablation (e.g., rising serum thyroglobulin). Tumors that are not visible on TBI in spite of elevated thyroglobulin may have become less well differentiated and may no longer metabolize iodide. These patients may benefit from fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scanning, since FDG accumulates in dedifferentiated tumors.

This chapter describes the role, technique, and imaging findings of patients with known or suspected recurrent or metastatic disease in patients with well-differentiated thyroid cancer. Knowledge of the strengths and limitations of the available imaging options will help the clinician optimize the management of patients with well-differentiated thyroid cancer.

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Authors and Affiliations

  1. Diagnostic Radiology, University of North Carolina-Chapel Hill Hospitals, Chapel Hill, NC, USA

    Jorge Daniel Oldan & Terry Zekon Wong

  2. Diagnostic Radiology, Duke University Medical Center, Durham, NC, USA

    Jenny Hoang

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  1. Jorge Daniel Oldan
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Correspondence to Jorge Daniel Oldan .

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  1. General Surgery, Central Arkansas Veterans Healthcare System, University of Arkansas, Little Rock, Arkansas, USA

    Anne T. Mancino

  2. Division of Surgical Oncology, University of North Carolina, Chapel Hill, North Carolina, USA

    Lawrence T. Kim

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Oldan, J.D., Hoang, J., Wong, T.Z. (2017). Imaging Modalities in the Diagnosis of Recurrent or Metastatic Thyroid Cancer. In: Mancino, A., Kim, L. (eds) Management of Differentiated Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-54493-9_19

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