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Annals of Nuclear Medicine

, Volume 29, Issue 7, pp 603–612 | Cite as

Prediction of treatment response to 131I therapy by diffuse hepatic uptake intensity on post-therapy whole-body scan in patients with distant metastases of differentiated thyroid cancer

  • Sungmin Jun
  • Jong Jin LeeEmail author
  • Seol Hoon Park
  • Tae Yong Kim
  • Won Bae Kim
  • Young Kee Shong
  • Jin-Sook Ryu
Original Article

Abstract

Objective

A diffuse hepatic uptake (DHU) on radioiodine whole-body scans (WBS) after 131I therapy is caused by 131I-labeled iodoproteins, particularly 131I-labeled thyroglobulin (Tg). We hypothesized that the DHU intensity after 131I therapy might correlate with subsequent serum Tg reduction, suggesting that DHU reflects destruction of functioning thyroid tissue as measured by serum Tg.

Materials and methods

We retrospectively reviewed the medical records and 131I WBSs of 47 patients treated with 131I therapy for distant metastasis from differentiated thyroid cancer (M:F = 15:32, median age 45 years, range 11–74 years). All patients received post-ablative 131I scans (PAWBS) at first 131I ablation after total thyroidectomy and post-therapy 131I scan (PTWBS) at second 131I therapy. The DHU intensities of the PAWBS and PTWBS were classified into 3 grades: 1, faint; 2, modest; and 3, intense. Serum thyroid-stimulating hormone-stimulated Tg (sTg) levels were measured at the time of each therapy and 1 year after the second 131I therapy.

Results

One year after the second 131I therapy, 10 patients (21.3 %) were in remission and 37 (78.7 %) had persistent disease. The DHU intensity on PAWBS correlated with the percentage sTg reduction at the next follow-up point (σ = 0.466, p = 0.0016). The patients with intense DHU on PTWBS tended to have a higher percentage sTg reduction than the other patients, although statistical significances were marginal (Spearman’s rank correlation: σ = 0.304, p = 0.054; Kruskal–Wallis test: p = 0.067). In univariate analysis, the DHU grades on PAWBS and the initial sTg levels were significantly different between patients in remission and those with persistent disease (PAWBS: p = 0.022; initial sTg: p = 0.0059). In multivariate logistic regression analysis, after adjusting for initial sTg levels, a DHU grade of 3 on PAWBS was an independent predictor of remission (PAWBS: p = 0.028; initial sTg <100 ng/ml: p = 0.043).

Conclusions

In patients with iodine-avid distant metastases, intensity of DHU on 131I post-therapy scan correlated with subsequent percentage serum sTg reduction. Also, intense DHU could be one of the predictors of remission in these patients.

Keywords

Differentiated thyroid cancer Distant metastasis Diffuse hepatic uptake 131I therapy Treatment response 

Notes

Acknowledgments

This work was supported by Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT and Future Planning (NRF-2012M2A2A7013480).

Conflict of interest

None.

References

  1. 1.
    Sampson E, Brierley JD, Le LW, Rotstein L, Tsang RW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis. Cancer. 2007;110:1451–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;174:474–6.PubMedCrossRefGoogle Scholar
  3. 3.
    Muresan MM, Olivier P, Leclere J, Sirveaux F, Brunaud L, Klein M, et al. Bone metastases from differentiated thyroid carcinoma. Endocr Relat Cancer. 2008;15:37–49.PubMedCrossRefGoogle Scholar
  4. 4.
    Lee J, Soh EY. Differentiated thyroid carcinoma presenting with distant metastasis at initial diagnosis clinical outcomes and prognostic factors. Ann Surg. 2010;251:114–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Schlumberger M, Challeton C, De Vathaire F, Travagli JP, Gardet P, Lumbroso JD, et al. Radioactive iodine treatment and external radiotherapy for lung and bone metastases from thyroid carcinoma. J Nucl Med. 1996;37:598–605.PubMedGoogle Scholar
  6. 6.
    Maxon HR 3rd, Smith HS. Radioiodine-131 in the diagnosis and treatment of metastatic well differentiated thyroid cancer. Endocrinol Metab Clin North Am. 1990;19:685–718.PubMedGoogle Scholar
  7. 7.
    Omur O, Akgun A, Ozcan Z, Sen C, OzkiIic H. Clinical implications of diffuse hepatic uptake observed in postablative and post-therapeutic I-131 scans. Clin Nucl Med. 2009;34:11–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Chung JK, Lee YJ, Jeong JM, Lee DS, Lee MC, Cho BY, et al. Clinical significance of hepatic visualization on iodine-131 whole-body scan in patients with thyroid carcinoma. J Nucl Med. 1997;38:1191–5.PubMedGoogle Scholar
  9. 9.
    Tatar FA, Morita E, Ituarte PH, Cavalieri RR, Duh QY, Price DC, et al. Association between residual thyroid carcinoma and diffuse hepatic uptake of 131I following radioiodine ablation in postoperative total thyroidectomy patients. World J Surg. 2001;25:718–22.PubMedCrossRefGoogle Scholar
  10. 10.
    Blum M. Hepatic visualization after 131I in patients with thyroid carcinoma. N Engl J Med. 1977;296:634.PubMedGoogle Scholar
  11. 11.
    McDougall IR. Whole-body scintigraphy with radioiodine-131. A comprehensive list of false-positives with some examples. Clin Nucl Med. 1995;20:869–75.PubMedCrossRefGoogle Scholar
  12. 12.
    Ferris HA, Williams G, Parker JA, Garber JR. Therapeutic implications of diffuse hepatic uptake following I-131 therapy for differentiated thyroid cancer. Endocr Pract. 2013;19:263–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Rosenbaum RC, Johnston GS, Valente WA. Frequency of hepatic visualization during I-131 imaging for metastatic thyroid carcinoma. Clin Nucl Med. 1988;13:657–60.PubMedCrossRefGoogle Scholar
  14. 14.
    Oppenheimer JH, Bernstein G, Hasen J. Estimation of rapidly exchangeable cellular thyroxine from the plasma disappearance curves of simultaneously administered thyroxine-131-I and albumin-125-I. J Clin Investig. 1967;46:762–77.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Pochin EE. Prospects from the treatment of thyroid carcinoma with radioiodine. Clin Radiol. 1967;18:113–25.PubMedCrossRefGoogle Scholar
  16. 16.
    Muratet JP, Giraud P, Daver A, Minier JF, Gamelin E, Larra F. Predicting the efficacy of first iodine-131 treatment in differentiated thyroid carcinoma. J Nucl Med. 1997;38:1362–8.PubMedGoogle Scholar
  17. 17.
    Bernier MO, Morel O, Rodien P, Muratet JP, Giraud P, Rohmer V, et al. Prognostic value of an increase in the serum thyroglobulin level at the time of the first ablative radioiodine treatment in patients with differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2005;32:1418–21.PubMedCrossRefGoogle Scholar
  18. 18.
    Cramp WA, Yatvin MB, Harms-Ringdahl M. Recent developments in the radiobiology of cellular membranes. Acta Oncol. 1994;33:945–52.PubMedCrossRefGoogle Scholar
  19. 19.
    Ramakrishnan N, McClain DE, Catravas GN. Membranes as sensitive targets in thymocyte apoptosis. Int J Radiat Biol. 1993;63:693–701.PubMedCrossRefGoogle Scholar
  20. 20.
    Lee JW, Lee SM, Koh GP, Lee DH. The comparison of (131)I whole-body scans on the third and tenth day after (131)I therapy in patients with well-differentiated thyroid cancer: preliminary report. Ann Nucl Med. 2011;25:439–46.PubMedCrossRefGoogle Scholar
  21. 21.
    Chong A, Song H-C, Min J-J, Jeong S, Ha J-M, Kim J, et al. Improved detection of lung or bone metastases with an I-131 whole body scan on the 7th day after high-dose I-131 therapy in patients with thyroid cancer. Nucl Med Mol Imaging. 2010;44:273–81.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Huang IC, Chou FF, Liu RT, Tung SC, Chen JF, Kuo MC, et al. Long-term outcomes of distant metastasis from differentiated thyroid carcinoma. Clin Endocrinol (Oxf). 2012;76:439–47.PubMedCrossRefGoogle Scholar
  23. 23.
    Kim K, Kim SJ, Kim IJ, Kim YK, Kim BS, Pak K. Clinical significance of diffuse hepatic visualization and thyroid bed uptake on post-ablative iodine-131 whole body scan in differentiated thyroid cancer. Onkologie. 2012;35:82–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Mazzaferri EL, Robbins RJ, Spencer CA, Braverman LE, Pacini F, Wartofsky L, et al. A consensus report of the role of serum thyroglobulin as a monitoring method for low-risk patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 2003;88:1433–41.PubMedCrossRefGoogle Scholar
  25. 25.
    Maayan ML, Eisenberg J, Lopez EM, Rothschild MA. Hepatic visualization after 131I in patients with thyroid carcinoma. N Engl J Med. 1976;295:1258–9.PubMedGoogle Scholar
  26. 26.
    Lee JW, Lee SM, Choi J. Clinical significance of diffuse hepatic uptake on post-therapeutic early and delayed (131)I scan in differentiated thyroid cancer: a preliminary report. Ann Nucl Med. 2015;29:190–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Durante C, Haddy N, Baudin E, Leboulleux S, Hartl D, Travagli JP, et al. Long-term outcome of 444 patients with distant metastases from papillary and follicular thyroid carcinoma: benefits and limits of radioiodine therapy. J Clin Endocrinol Metab. 2006;91:2892–9.PubMedCrossRefGoogle Scholar
  28. 28.
    Klubo-Gwiezdzinska J, Burman KD, Van Nostrand D, Mete M, Jonklaas J, Wartofsky L. Radioiodine treatment of metastatic thyroid cancer: relative efficacy and side effect profile of preparation by thyroid hormone withdrawal versus recombinant human thyrotropin. Thyroid. 2012;22:310–7.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2015

Authors and Affiliations

  • Sungmin Jun
    • 1
  • Jong Jin Lee
    • 2
    Email author
  • Seol Hoon Park
    • 3
  • Tae Yong Kim
    • 4
  • Won Bae Kim
    • 4
  • Young Kee Shong
    • 4
  • Jin-Sook Ryu
    • 2
  1. 1.Department of Nuclear Medicine, Kosin University Gospel HospitalKosin University College of MedicineBusanKorea
  2. 2.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
  3. 3.Department of Nuclear Medicine, Ulsan University HospitalUniversity of Ulsan College of MedicineUlsanKorea
  4. 4.Department of Endocrinology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea

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