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¹⁸F-FDG PET Detection of Lymph Node Metastases in Medullary Thyroid Carcinoma

¹ PET Center, University of Debrecen, Debrecen, Hungary
² Department of Radiotherapy, National Institute of Oncology, Budapest, Hungary
³ Department of Radiotherapy, Semmelweis University, Budapest, Hungary
⁴ Diagnostic Center, University of Kaposvár, Kaposvár, Hungary
⁵ Department of Surgery and Transplantation, Semmelweis University, Budapest, Hungary
⁶ Department of Nuclear Medicine, National Institute of Oncology, Budapest, Hungary

Postsurgically elevated or increasing serum calcitonin levels strongly suggest the presence of residual or recurrent medullary thyroid carcinoma (MTC). Several imaging modalities (sonography, MRI, CT, scintigraphy with different types of radiolabeled ligands, etc.) are routinely used in an attempt to localize tumorous tissue, but such efforts often fail. In the search for a more reliable method, ¹⁸F-FDG PET was applied to detect tumor tissue of residual or recurrent MTC. Methods: Forty patients with a postoperatively elevated plasma calcitonin level were included. These patients underwent routine diagnostic imaging procedures (CT, MRI, and ¹³¹I-metaiodobenzylguanidine [MIBG] whole-body planar scintigraphy or SPECT) and ¹⁸F-FDG PET examinations. Two independent experts visually analyzed the images provided by each method to detect pathologic lesions. Lymph nodes of 1 cm in short diameter that were detected by radiologic methods were considered to be pathologic. ¹⁸F-FDG accumulation with a sharp contour reported by both independent observers was similarly regarded as pathologic. Results: PET detected 270 foci with a high tracer accumulation, whereas only 116 lesions were detected by MRI and 141 by CT. The numbers of such foci determined by PET, MRI, and CT were 98, 34, and 34, respectively, in the neck; 25, 5, and 6, respectively, in the supraclavicular regions; and 117, 35, and 39, respectively, in the mediastinum. ¹³¹I-MIBG scintigraphy findings were positive for only 3 patients. Conclusion: For MTC patients with a postoperatively elevated plasma tumor marker level, PET was more sensitive and superior in localizing tumorous lymph node involvement than were the other imaging modalities, especially in the cervical, supraclavicular, and mediastinal lymphatic regions.

Key Words: PET • ¹⁸F-FDG • medullary thyroid cancer • lymph node metastasis

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