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Der Radiologe

, Volume 59, Issue 11, pp 992–1001 | Cite as

Bildgebung beim medullären Schilddrüsenkarzinom

  • M. UhrigEmail author
  • S. Delorme
Leitthema
  • 124 Downloads

Zusammenfassung

Hintergrund

Das medulläre Schilddrüsenkarzinom („medullary thyroid carcinoma“, MTC) macht etwa 10 % aller Schilddrüsenkarzinome aus und tritt sporadisch, familiär und im Rahmen einer multiplen endokrinen Neoplasie (MEN) Typ 2 auf. Bildgebende Verfahren spielen eine zentrale Rolle beim Screening in betroffenen Familien sowie in der Diagnostik.

Diagnostische Methoden

Die Diagnose erfolgt anhand von Sonographie, Szintigraphie, Serum-Kalzitonin und -CEA (karzinoembryonales Antigen) sowie Feinnadelpunktion. Führendes Verfahren zum lokoregionären Staging ist die hochauflösende Sonographie in Verbindung mit der Computertomographie (CT) des Mediastinums. Die Positronenemissionstomographie-Computertomographie (PET-CT) mit 18-F-DOPA eignet sich insbesondere zur Suche nach okkulten Metastasen bei ansteigenden Werten von Kalzitonin und CEA.

Befunde und Krankheitsverlauf

Die Diagnose ergibt sich aus der Zytologie eines sonographisch meist echoarmen, szintigraphisch kalten Schilddrüsenknotens in Verbindung mit einer Erhöhung von Kalzitonin und CEA im Serum. Die Sonographie stellt das führende bildgebende Routineverfahren im postoperativen Verlauf dar. Die CT ist indiziert bei Verdacht auf mediastinale, pulmonale oder Lebermetastasen. Im Verlauf sollte diese möglichst früh durch die MRT ersetzt werden, um langfristig hohe kumulative Strahlendosen zu vermeiden.

Neuere klinische Entwicklungen

Aufgrund seiner Strahlen- und Chemoresistenz ist das MTC zwar nur chirurgisch heilbar, aber aufgrund des langsamen Spontanverlaufs überleben auch Patienten mit Metastasen häufig 10 Jahre oder länger. Für aggressive Varianten oder symptomatische, späte Stadien befinden sich zielgerichtete Substanzen in klinischer Erprobung oder sind bereits zugelassen und können einen Stillstand oder sogar eine Teilremission der Erkrankung bewirken.

Schlüsselwörter

Schilddrüsenknoten Neuroendokrine Tumoren Multiple endokrine Neoplasie Staging Sonographie 

Abkürzungen

CEA

Karzinoembryonales Antigen

CEUS

Kontrastmittelgestützter Ultraschall

LK

Lymphknoten

MEN

Multiple endokrine Neoplasien

MTC

Medulläres Schilddrüsenkarzinom

Imaging of medullary thyroid carcinoma

Abstract

Background

About 10% of thyroid cancers are medullary thyroid carcinoma (MTC) and can occur sporadically, familially and in the context of type II multiple endocrine neoplasia (MEN). Imaging plays a pivotal role in screening family members and in diagnosis.

Diagnostic methods

Diagnosis is based on ultrasound (US), thyroid scintigraphy, serum calcitonin and carcinoembryonic antigen (CEA) as well as fine needle biopsy. High-resolution US is the most important imaging method for locoregional staging, combined with computed tomography (CT) of the mediastinum. Positron emission tomography (PET-CT) using 18-F-DOPA is particularly suited for suspected occult metastases in case of rising tumor markers in serum.

Findings and course of disease

Diagnosis is made based on cytologic findings in a hypoechoic, cold thyroid nodule, combined with an elevation of serum calcitonin and CEA. US is the most important imaging modality during routine follow-up. CT is indicated for suspected mediastinal, lung, or liver metastases. CT should be replaced by MRI as early as possible to prevent significant cumulative radiation doses over time.

Recent clinical developments

Although MTC is curable by surgery only, owing to its radio- and chemoresistance, the disease will often progress only slowly, and even patients with metastases will frequently survive 10 years or longer. For more aggressive variants and late symptomatic stages, targeted drugs that have the potential to indicate stabilization or even a partial remission of the disease are under clinical investigation or already approved.

Keywords

Thyroid nodules Neuroendocrine tumors Multiple endocrine neoplasia Staging Ultrasonography 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

M. Uhrig und S. Delorme geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Ahn JE, Lee JH, Yi JS et al (2008) Diagnostic accuracy of CT and ultrasonography for evaluating metastatic cervical lymph nodes in patients with thyroid cancer. World J Surg 32:1552–1558CrossRefGoogle Scholar
  2. 2.
    Alonso-Gordoa T, Diez JJ, Duran M et al (2015) Advances in thyroid cancer treatment: latest evidence and clinical potential. Ther Adv Med Oncol 7:22–38CrossRefGoogle Scholar
  3. 3.
    Anonymus ESUR Guidelines on contrast agents V 10.0. http://www.esur-cm.org/index.php/de/
  4. 4.
    Antoun S, Birdsell L, Sawyer MB et al (2010) Association of skeletal muscle wasting with treatment with sorafenib in patients with advanced renal cell carcinoma: results from a placebo-controlled study. J Clin Oncol 28:1054–1060CrossRefGoogle Scholar
  5. 5.
    Cantisani V, Grazhdani H, Fioravanti C et al (2014) Liver metastases: contrast-enhanced ultrasound compared with computed tomography and magnetic resonance. World J Gastroenterol 20:9998–10007CrossRefGoogle Scholar
  6. 6.
    Choi H, Charnsangavej C, Faria SC et al (2007) Correlation of computed tomography and positron emission tomography in patients with metastatic gastrointestinal stromal tumor treated at a single institution with imatinib mesylate: proposal of new computed tomography response criteria. J Clin Oncol 25:1753–1759CrossRefGoogle Scholar
  7. 7.
    Choi N, Moon WJ, Lee JH et al (2011) Ultrasonographic findings of medullary thyroid cancer: differences according to tumor size and correlation with fine needle aspiration results. Acta Radiol 52:312–316CrossRefGoogle Scholar
  8. 8.
    Ctvrtlik F, Koranda P, Schovanek J et al (2018) Current diagnostic imaging of pheochromocytomas and implications for therapeutic strategy. Exp Ther Med 15:3151–3160PubMedPubMedCentralGoogle Scholar
  9. 9.
    D’onofrio M, Crosara S, De Robertis R et al (2014) Malignant focal liver lesions at contrast-enhanced ultrasonography and magnetic resonance with hepatospecific contrast agent. Ultrasound 22:91–98CrossRefGoogle Scholar
  10. 10.
    De Luca S, Fonti R, Camera L et al (2016) Multimodal imaging with (18)F-FDG-PET/CT and (111)In-Octreotide SPECT in patients with metastatic medullary thyroid carcinoma. Ann Nucl Med 30:234–241CrossRefGoogle Scholar
  11. 11.
    Delorme S, Raue F (2015) Medullary thyroid carcinoma: imaging. Recent Results Cancer Res 204:91–116CrossRefGoogle Scholar
  12. 12.
    Dralle H (2018) The new TNM classification for thyroid cancer. Chirurg 89:389CrossRefGoogle Scholar
  13. 13.
    Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247CrossRefGoogle Scholar
  14. 14.
    Fard N, Schlemmer HP, Raue F et al (2019) CT- and ultrasound-characteristics of hepatic lesions in patients with multiple endocrine neoplasia syndrome. A retrospective image review of 25 cases. PLoS ONE 14:e212865CrossRefGoogle Scholar
  15. 15.
    Foschini MP, Ragazzi M, Parmeggiani AL et al (2007) Comparison between echo-color Doppler sonography features and angioarchitecture of thyroid nodules. Int J Surg Pathol 15:135–142CrossRefGoogle Scholar
  16. 16.
    Ganeshan D, Paulson E, Duran C et al (2013) Current update on medullary thyroid carcinoma. Ajr Am J Roentgenol 201:W867–W876CrossRefGoogle Scholar
  17. 17.
    Ghatalia P, Je Y, Mouallem NE et al (2015) Hepatotoxicity with vascular endothelial growth factor receptor tyrosine kinase inhibitors: a meta-analysis of randomized clinical trials. Crit Rev Oncol Hematol 93:257–276CrossRefGoogle Scholar
  18. 18.
    Ghatalia P, Morgan CJ, Choueiri TK et al (2015) Pancreatitis with vascular endothelial growth factor receptor tyrosine kinase inhibitors. Crit Rev Oncol Hematol 94:136–145CrossRefGoogle Scholar
  19. 19.
    Guerin C, Lowery A, Gabriel S et al (2015) Preoperative imaging for focused parathyroidectomy: making a good strategy even better. Eur J Endocrinol 172:519–526CrossRefGoogle Scholar
  20. 20.
    Ha EJ, Baek JH, Na DG et al (2015) The role of core needle biopsy and its impact on surgical management in patients with medullary thyroid cancer: clinical experience at 3 medical institutions. Ajnr Am J Neuroradiol 36:1512–1517CrossRefGoogle Scholar
  21. 21.
    Hansford JR, Mulligan LM (2000) Multiple endocrine neoplasia type 2 and RET: from neoplasia to neurogenesis. J Med Genet 37:817–827CrossRefGoogle Scholar
  22. 22.
    Kelil T, Keraliya AR, Howard SA et al (2016) Current concepts in the molecular genetics and management of thyroid cancer: an update for radiologists. Radiographics 36:1478–1493CrossRefGoogle Scholar
  23. 23.
    Kim BH, Kim IJ (2016) Recent updates on the management of medullary thyroid carcinoma. Endocrinol Metab (seoul) 31:392–399CrossRefGoogle Scholar
  24. 24.
    Kim SH, Kim BS, Jung SL et al (2009) Ultrasonographic findings of medullary thyroid carcinoma: a comparison with papillary thyroid carcinoma. Korean J Radiol 10:101–105CrossRefGoogle Scholar
  25. 25.
    King AD (2008) Imaging for staging and management of thyroid cancer. Cancer Imaging 8:57–69CrossRefGoogle Scholar
  26. 26.
    Leclere J, Sidibe S, Lassau N et al (1996) Ultrasonographic aspects of hepatic metastases of thyroid medullary cancers. J Radiol 77:99–103PubMedGoogle Scholar
  27. 27.
    Lee S, Shin JH, Han BK et al (2010) Medullary thyroid carcinoma: comparison with papillary thyroid carcinoma and application of current sonographic criteria. Ajr Am J Roentgenol 194:1090–1094CrossRefGoogle Scholar
  28. 28.
    Marcus C, Whitworth PW, Surasi DS et al (2014) PET/CT in the management of thyroid cancers. Ajr Am J Roentgenol 202:1316–1329CrossRefGoogle Scholar
  29. 29.
    Mccook TA, Putman CE, Dale JK et al (1982) Review: Medullary carcinoma of the thyroid: radiographic features of a unique tumor. Ajr Am J Roentgenol 139:149–155CrossRefGoogle Scholar
  30. 30.
    Nafisi Moghadam R, Amlelshahbaz AP, Namiranian N et al (2017) Comparative diagnostic performance of ultrasonography and 99mTc-Sestamibi scintigraphy for parathyroid adenoma in primary hyperparathyroidism; systematic review and meta-analysis. Asian Pac J Cancer Prev 18:3195–3200PubMedGoogle Scholar
  31. 31.
    Siano M, Alfieri S, Granata R et al (2019) The dilemma of metastatic medullary thyroid carcinoma: when to start systemic treatment. Tumori 2019:300891619829571Google Scholar
  32. 32.
    Solbiati L, Osti V, Cova L et al (2001) Ultrasound of thyroid, parathyroid glands and neck lymph nodes. Eur Radiol 11:2411–2424CrossRefGoogle Scholar
  33. 33.
    Sung JY (2015) Parathyroid ultrasonography: the evolving role of the radiologist. Ultrasonography 34:268–274CrossRefGoogle Scholar
  34. 34.
    Treglia G, Castaldi P, Villani MF et al (2012) Comparison of 18F-DOPA, 18F-FDG and 68 Ga-somatostatin analogue PET/CT in patients with recurrent medullary thyroid carcinoma. Eur J Nucl Med Mol Imaging 39:569–580CrossRefGoogle Scholar
  35. 35.
    Treglia G, Cocciolillo F, Di Nardo F et al (2012) Detection rate of recurrent medullary thyroid carcinoma using fluorine-18 dihydroxyphenylalanine positron emission tomography: a meta-analysis. Acad Radiol 19:1290–1299CrossRefGoogle Scholar
  36. 36.
    Treglia G, Rufini V, Salvatori M et al (2012) PET imaging in recurrent medullary thyroid carcinoma. Int J Mol Imaging 2012:324686PubMedPubMedCentralGoogle Scholar
  37. 37.
    Triggiani V, Guastamacchia E, Licchelli B et al (2008) Microcalcifications and psammoma bodies in thyroid tumors. Thyroid 18:1017–1018CrossRefGoogle Scholar
  38. 38.
    Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/Tumor-Node-Metastasis Staging System for Differentiated and Anaplastic Thyroid Cancer (Eighth Edition): What changed and why? Thyroid 27:751–756CrossRefGoogle Scholar
  39. 39.
    Wells SA Jr., Asa SL, Dralle H et al (2015) Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid 25:567–610CrossRefGoogle Scholar
  40. 40.
    Wolinski K, Rewaj-Losyk M, Ruchala M (2014) Sonographic features of medullary thyroid carcinomas—a systematic review and meta-analysis. Endokrynol Pol 65:314–318CrossRefGoogle Scholar
  41. 41.
    Yasir M, Kasi A (2019) Multiple Endocrine Neoplasias, Type 2 (MEN II, Pheochromocytoma and Amyloid Producing Medullary Thyroid Carcinoma, Sipple Syndrome). StatPearls, Treasure IslandGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Abteilung Radiologie (E010)Deutsches Krebsforschungszentrum (DKFZ)HeidelbergDeutschland

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