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Comparison of ^99mTc-Methoxyisobutyl Isonitrile and ²⁰¹Tl Scintigraphy for Detection of Residual Thyroid Cancer After ¹³¹I Ablative Therapy

Departments of Radiology and Surgery, University of Iowa College of Medicine, Iowa City, Iowa
Department of Radiology, Medical College of Wisconsin, Madison, Wisconsin

Correspondence: For correspondence or reprints contact: James E. Seabold, MD, Department of Radiology, The University of Iowa Hospitals and Clinics, 200 Hawkins Dr., Iowa City, IA 52242.

ABSTRACT

In this study, we compared ^99mTc-methoxyisobutyl isonitrile (MIBI) with ²⁰¹Tl scintigraphy for the detection of residual thyroid cancer not found by ¹³¹I scans in patients with increased risk of recurrence after ¹³¹I therapy. Methods: ²⁰¹Tl and MIBI scans were obtained in 54 patients with negative ¹³¹I scans 3–25 y (median 7.9 y) after the first postsurgical ¹³¹I therapy. Serum thyroglobulin (Tg) levels were measured while patients were receiving thyroid hormone and again 6 wk after withdrawal of hormone therapy. Results: The overall results were the same for both ²⁰¹Tl and MIBI imaging, with a sensitivity of 19 of 36 (53%), specificity of 17 of 17 (100%) and accuracy of 36 of 54 (69%). Planar images missed residual cancer in high cervical lymph nodes adjacent to salivary gland activity, in small nodes (<1 cm) deep in the neck or chest and with diffuse pulmonary micrometastases. Serum Tg was elevated in 24 of 36 (67%) patients with residual cancer; ²⁰¹Tl detected tumor sites in 13 of 24 (54%) of these patients, and MIBI detected tumor sites in 14 of 24 (58%) of these patients. Of the 12 patients who had residual cancer and false-negative serum Tg levels, 6 had true-positive ²⁰¹Tl and 5 had true-positive MIBI scans. Conclusion: ²⁰¹Tl and MIBI planar imaging yield the same high specificity and positive predictive value for residual thyroid cancer in patients with high-risk profiles and negative radioiodide scans. Both imaging agents detected residual cancer in more than half of the patients in whom conventional staging techniques did not reliably detect either the presence or the extent of residual thyroid cancer and changed the management in patients with surgically resectable cancer.

Key Words: thyroid carcinoma • ^99mTc-methoxyisobutyl isontrile • ²⁰¹Tl • serum thyroglobulin

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