Abstract
Objective: It has been reported that delayed scan of thallium-201 (201Tl) scintigraphy is useful for differentiating malignant tumors from benign lesions and for evaluating treatment response. However, physiological muscle uptake which usually increases in delayed scans, often makes it difficult to evaluate201T1 uptake and its washout in bone and soft-tissue tumors. The purpose of this study was to evaluate whether the delayed scan is necessary and whether a dynamic scan is useful in the evaluation of bone and soft-tissue tumors.Methods: We studied 175 cases of bone and soft-tissue tumors (malignant 45, benign 130). Dynamic scans were acquired every 5 seconds for 10 minutes after201T1 injection, and time activity curves (TACs) were generated by adaptive smoothing methods. Early and delayed scans were acquired at 10–15 minutes and 2 hours after injection.20lTl images were visually interpreted and the radioactivity count ratio (T/N) of tumors to normal tissues and washout rate [WR = (early T/N - delayed T/N)/early T/N] were denned.Results: When there were no201T1 uptake in dynamic (n = 67) and early scans (n = 68), no tumor uptake was also appreciated in delayed scans, and all but two cases of negative scans were benign. In 107 lesions, although there were significant differences in T/Ns between malignant and benign lesions both on early scans (2.84 ± 1.45 vs. 2.05 ± 1.13, p < 0.05) and delayed scans (2.17 ± 1.03 vs. 1.58 ± 0.64, p < 0.05), there was a substantial overlap. The T/Ns decreased in delayed scans (i.e., WR > 0) in 100 of 107 cases due to increase of surrounding muscle uptake, and there was no difference in WR between malignant tumors and benign lesions (0.21 ± 0.14 vs. 0.19 ± 0.14).Conclusions: For evaluating bone and soft-tissue tumors, delayed scan had little clinical usefulness and it may be time consuming. Dynamic scan would be useful for demonstrating the differences between tumor blood flow and201Tl uptake in tumors.
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Tonami N, Shuke N, Yokoyama K, Seki H, Takayama T, Kinuya S, et al. Thallium-201 single photon emission computed tomography in the evaluation of suspected lung cancer.J Nucl Med 1989; 30:997–1004.
Ramanna L, Waxman A, Binney G, Waxman S, Mirra J, Rosen G. Thallium-201 scintigraphy in bone sarcoma: comparison with gallium-67 and technetium-MDP in the evaluation of chemotherapeutic response.J Nucl Med 1990; 31:567–572.
Kim KT, Black KL, Marciano D, Mazziotta JC, Guze BH, Grafton S, et al. Thallium-201 SPECT imaging of brain tumors: methods and results.J Nucl Med 1990; 31:965–969.
Van der Wall H, Murray IP, Huckstep RL, Philips RL. The role of thallium scintigraphy in excluding malignancy in bone.Clin Nucl Med 1993; 18:551–557.
Oriuchi N, Tamura M, Shibazaki T, Ohye C, Watanabe N, Tateno M, et al. Clinical evaluation of thallium-201 SPECT in supratentorial gliomas: relationship to histologic grade, prognosis and proliferative activities.J Nucl Med 1993; 34:2085–2089.
Caluser CI, Abdel-Dayem HM, Macapinlac HA, Scott A, Healey JH, Huvos A, et al. The value of thallium and three-phase bone scans in the evaluation of bone and soft tissue sarcomas.Eur J Nucl Med 1994; 21:1198–1205.
Abdel-Dayem HM. The role of nuclear medicine in primary bone and soft tissue tumors.Semin Nucl Med 1997; 27:355–363.
Sumiya H, Taki J, Tsuchiya H, Nonomura A, Miyauchi T, Tonami N. Midcourse thallium-201 scintigraphy to predict tumor response in bone and soft-tissue tumors.J Nucl Med 1998; 39:1600–1604.
Sun D, Liu Q, Liu W, Hu W. Clinical application of201Tl SPECT imaging of brain tumors.J Nucl Med 2000; 41:5–10.
Ochi H, Sawa H, Fukuda T, Inoue Y, Nakajima H, Masuda Y, et al. Thallium-201-chloride thyroid scintigraphy to evaluate benign and/or malignant nodules: usefulness of the delayed scan.Cancer 1982; 50:236–240.
Jinnouchi S, Hoshi H, Ohnishi T, Futami S, Nagamachi S, Watanabe K, et al. Thallium-201 SPECT for predicting histological types of meningiomas.J Nucl Med 1993; 34:2091–2094.
Abdel-Dayem H.201Tl-chloride uptake ratios in differentiating benign from malignant lesions: recommendations for ratio calculations and interpretation.Nucl Med Commun 1995; 16:145–149.
Nakada K, Katoh C, Kanegae K, Tsukamoto E, Itoh K, Furudate M, et al. The role of201T1 scintigraphy in evaluating proliferative activity in thyroid neoplasms.Ann Nucl Med 1996; 10:41–48.
Nakada K, Katoh C, Kanegae K, Tsukamoto E, Shiga T, Mochizuki T, et al. Thallium-201 scintigraphy to predict therapeutic outcome of iodine-131 therapy of metastatic thyroid carcinoma.J Nucl Med 1998; 39:807–810.
Nishiyama Y, Yamamoto Y, Toyama Y, Satoh K, Ohkawa M, Tanabe M. Diagnostic value of Tl-201 and three-phase bone scintigraphy for bone and soft-tissue tumors.Clin Nucl Med 2000; 25:200–205.
Sato O, Kawai A, Ozaki T, Kunisada T, Danura T, Inoue H. Value of thallium-201 scintigraphy in bone and soft tissue tumors.J Orthop Sci 1998; 3:297–303.
Yoshikawa M, Sugawara Y, Kikuchi T, Nakata S, Mochizuki T, Ikezoe J, et al. Two cases of pediatric bone disease (eosinophilic granuloma and Brodie’s abscess) showing similar scintigraphic and radiographie findings.Clin Nucl Med 2000; 25:986–990.
Degirmenci B, Mavi A, Ozkal S, Itil O, Havitcioglu H, Ozaksoy D, et al. Tl-201 uptake in bone and soft tissue involvement of sarcoidosis.Clin Nucl Med 2001 ; 26:499–501.
Sumiya H, Taki J, Higuchi T, Tonami N. Nuclear imaging of bone tumors: thallium-201 scintigraphy.Semin Musculoskelet Radiol 2001; 5:177–182.
Kawata S, Minami S. Adaptive smoothing of spectroscopic data by a linear mean-square estimation.Applied Spectroscopy 1984; 38:49–58.
Kostakoglu L, Panicek DM, Divgi CR, Botet J, Healey J, Larson SM, et al. Correlation of the findings of thallium-201 chloride scans with those of other imaging modalities and histology following therapy in patients with bone and soft tissue sarcomas.Eur J Nucl Med 1995; 22:1232–1237.
Terui S, Terauchi T, Abe H, Fukuma H, Beppu Y, Chuman K, et al. On clinical usefulness of Tl-201 scintigraphy for the management of malignant soft tissue tumors.Ann Nucl Med 1994; 8:55–64.
Goto Y, Ihara K, Kawauchi S, Ohi R, Sasaki K, Kawai S. Clinical significance of thallium-201 scintigraphy in bone and soft tissue tumors.J Orthop Sci 2002; 7:304–312.
Kanegawa K. Usefulness of a201Tl dynamic study of thyroid tumors.Nippon Igaku Hoshasen Gakkai Zasshi 1990; 50:180–191.
Kransdorf MJ. Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location.AJR Am J Roentgenol 1995; 164:395–402.
Kransdorf MJ. Malignant soft-tissue tumors in a large referral population: distribution of diagnoses by age, sex, and location.AJR Am J Roentgenol 1995; 164:129–134.
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Sugawara, Y., Kikuchi, T., Kajihara, M. et al. Thallium-201 scintigraphy in bone and soft-tissue tumors: a comparison of dynamic, early and delayed scans. Ann Nucl Med 19, 461–468 (2005). https://doi.org/10.1007/BF02985573
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DOI: https://doi.org/10.1007/BF02985573