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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

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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.

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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).

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Authors and Affiliations

  1. Department of Nuclear Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea

    Sungmin Jun

  2. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, Korea

    Jong Jin Lee & Jin-Sook Ryu

  3. Department of Nuclear Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea

    Seol Hoon Park

  4. Department of Endocrinology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

    Tae Yong Kim, Won Bae Kim & Young Kee Shong

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  1. Sungmin Jun
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Correspondence to Jong Jin Lee.

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Jun, S., Lee, J.J., Park, S.H. et al. 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. Ann Nucl Med 29, 603–612 (2015). https://doi.org/10.1007/s12149-015-0983-5

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  • DOI: https://doi.org/10.1007/s12149-015-0983-5

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