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Clinical Significance of Hepatic Visualization on Iodine-131 Whole-Body Scan in Patients with Thyroid Carcinoma

Departments of Nuclear Medicine and Internal Medicine, Seoul National University Hospital, Seoul, Korea

Correspondence: For correspondence or reprints: June-Key Chung, MD, Department of Nuclear Medicine, Seoul National University Hospital, 28 Yungun-dong, Chongno-gu, Seoul 110-744, Korea.

ABSTRACT

The purpose of this study was to evaluate the frequency and clinical significance of diffuse hepatic uptake on ¹³¹I whole-body scan in 399 patients (53 males, 346 females) with well-differentiated adeno-carcinomas of the thyroid. Methods: Two hundred and ninety-one diagnostic scans were performed 2 days after the administration of 74-370 MBq (2-10 mCi) ¹³¹I, and 824 post-therapy scans were done 3-5 days after the administration of 1.11-7.4 GBq (30-200 mCi) ¹³¹I. There was no evidence of liver metastasis in these patients. Liver and thyroid visualization on each ¹³¹I scan were graded from 0-4. To evaluate the incorporation of radioiodine to thyroglobulin and thyroid hormones, a patient's serum was extracted by 80% ethanol/20% trichloroacetic acid solution and analyzed by silica gel thin-layer chromatography. Results: Diffuse hepatic uptake (>Grade 2) was definitely seen in 239 of 399 (59.9%) of the patients and 397 of 1115 (35.6%) of the studies. In the diagnostic scans, 36 (12.0%) showed uptake in the liver. In post-therapy scans, however, the incidence of liver uptake increased according to increased doses of ¹³¹I (39.1% with 1.11 GBq, 61.5% with 2.775-3.7 GBq and 71.3% with 5.55-7.4 GBq). The more that uptake appeared in the residual thyroid, the more it appeared in the liver. There were 13 patients whose scans showed metastatic and liver uptake without any thyroid uptake. Fifteen patients showed diffuse liver uptake without uptake by the thyroid or metastasis. Follow-up studies of seven of these patients revealed metastatic lesions. Liver uptake on scan related to the fraction of ¹³¹I-labeled thyroglobulin in the serum. Conclusion: Diffuse liver uptake indicated functioning thyroid remnant or metastasis. In a few cases, liver uptake without uptake by the thyroid or metastasis on whole-body scans suggests hidden metastases.

Key Words: liver • iodine-131 whole-body scan • thyroid cancer • metastasis

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