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Clinical Usefulness of Fusion of ¹³¹I SPECT and CT Images in Patients with Differentiated Thyroid Carcinoma

Department of Radiology, Faculty of Medicine, Kagawa Medical University, Kagawa, Japan

Precise localization of the foci of ¹³¹I uptake for management of patients with differentiated thyroid carcinoma can be difficult because of a lack of anatomic landmarks. The objective of the present study was to demonstrate the clinical usefulness of ¹³¹I SPECT/CT fusion images in patients with differentiated thyroid carcinoma. Methods: CT and SPECT were performed 7 d after administration of a therapeutic dose of ¹³¹I to 17 patients with differentiated thyroid carcinoma. External markers were placed at 3 locations on the skin of the patient to adjust the sections of CT and SPECT in the same geometric plane. Fusion images were constructed by combining the digital CT and SPECT images on a computer workstation. The data from both planar and SPECT ¹³¹I images and CT images were first separately assessed by 2 nuclear medicine physicians. ¹³¹I SPECT/CT fusion images were then interpreted. Fusion images were considered to improve image interpretation in comparison with CT and scintigraphy separately when they provided better localization of sites of increased radiopharmaceutical uptake. Results: Both CT and ¹³¹I SPECT showed the pathologic sites in 5 of 17 patients (29%). Fusion images were considered to be of benefit in 15 of 17 patients (88%). In 4 patients, CT showed normal-sized lymph nodes, whereas ¹³¹I SPECT showed abnormal findings. In 3 patients with bone metastasis, fusion images confirmed the precision of the localization of abnormal ¹³¹I uptake. Five bone metastases and 1 muscle metastasis were occult and were not seen on the CT images. Finally, ¹³¹I scintigraphy findings were abnormal for 2 patients for whom the CT findings were initially considered normal. Fusion images confirmed the precision of the localization of physiologic ¹³¹I uptake. Conclusion: For registration of anatomic and functional images in fusion imaging, the method using external markers was simple and practical. ¹³¹I SPECT/CT fusion images using this technique may improve anatomically limited interpretation of ¹³¹I scintigraphy alone in patients with differentiated thyroid carcinoma.

Key Words: ¹³¹I • CT • fusion image • thyroid carcinoma

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