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Hürthle Cell Tumor Dwelling in Hot Thyroid Nodules: Preoperative Detection with Technetium-99m-MIBI Dual-Phase Scintigraphy

Nuclear Medicine Unit, Institute of Pathology, University of Siena, Siena, Italy

Correspondence: For correspondence or reprints contact: Angelo Vattimo, MD, Nuclear Medicine Unitof the University of Siena, Le Scotte Hospital, Viale Bracci, 53100 Siena, Italy.

ABSTRACT

Single injection dual-phase scintigraphy (early and late acquisitions) with ^99mTc-MIBI was used to differentiate benign and malignant hot thyroid nodules. Methods: Thirteen euthyroid and two hyperthyroid patients displaying a hot thyroid nodule on the ^99mTc scan due to an autonomously functioning thyroid nodule (AFTN) underwent early 15–30 min) and late (3–4 hr) thyroid scintigraphy after the administration of 740–1000 MBq ^99mTc-MIBI. Visual scoring was done to assess nodular tracer uptake and retention. In addition, the nodular-to-thyroid (N/T) uptake ratio in the early and late image and the washout rates (WO) from the nodule and thyroidal tissue were measured. All patients underwent thyroid surgery. Results: Histopathology revealed a Hörthle cell tumor in three nodules, a benign adenoma with oxyphilic metaplasia in two nodules and a benign adenoma without oxyphilic cells in the remaining 10 nodules. The Hörthle cell tumor nodules displayed intense and persistent uptake of ^99mTc-MIBI (N/T was 2.81 ± 0.52 and 5.53 ± 1.06 in early and late images, respectively; WO from the nodule was 12.33 ± 0.47, WO from the thyroidal tissue was 22.00 ± 3.56). The benign nodules showed intense uptake in the early image and intense uptake to absent retention in the late image (N/T was 2.94 ± 1.31 and 1.62 ± 0.50 in the early and late images, respectively; WO from the nodule was 20.25 ± 2.92, WO from the thyroidal tissue was 20.33 ± 2.92). Conclusion: Single injectiondual-phase ^99mTc-MIBI scintigraphy of the thyroid with AFTN can identify nodules as a result of the activity of a Höthle cell tumor, since these tumors cause intense and persistent tracer uptake in contrast with a benign AFTN.

Key Words: thyroid scintigraphy • technetium-99m-sestamibi • ot nodules • Hörthlecells tumor

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