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Integrated PET/CT in Differentiated Thyroid Cancer: Diagnostic Accuracy and Impact on Patient Management

¹ Department of Nuclear Medicine, University Hospital of Bonn, Bonn, Germany; ² Department of Radiology, University Hospital of Bonn, Bonn, Germany; ³ Department of Surgery, University Hospital of Bonn, Bonn, Germany; and ⁴ Department of Pathology, University Hospital of Bonn, Bonn, Germany

Correspondence: For correspondence or reprints contact: Holger Palmedo, MD, Department of Nuclear Medicine, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany. E-mail: holger.palmedo{at}ukb.uni-bonn.de

The aim of this study was to investigate the diagnostic accuracy and impact on patient management of the new integrated PET/CT modality in patients with suspected iodine-negative, differentiated thyroid carcinoma (DTC). Methods: Forty patients with DTC and a suggestion of iodine-negative tumor tissue underwent PET/CT examination (370 MBq ¹⁸F-FDG, coregistered PET/CT whole-body images). As the first step of analysis, PET and CT images were scored blindly and independently by 2 nuclear medicine physicians and 2 radiologists. A 5-point scale was used. The second step consisted of a consensus reading, during which a virtual side-by-side fusion of PET and CT images was initially evaluated and afterward the "real" fusion (i.e., coregistered) PET/CT images were also scored with the same 5-point scale. The imaging results were compared with histopathologic findings and the course of disease during further follow-up examinations. Results: One hundred twenty-seven lesions in 40 patients were evaluated. Diagnostic accuracy was 93% and 78% for PET/CT and PET, respectively (P = 0.049, per-patient analysis). In 17 (74%) of 23 patients with suspicious ¹⁸F-FDG foci, integrated PET/CT added relevant information to the side-by-side interpretation of PET and CT images by precisely localizing the lesion(s). In tumor-positive PET patients, PET/CT fusion by coregistration led to a change of therapy in 10 (48%) patients. Futile surgery was prevented in an additional 3 patients. Conclusion: Integrated PET/CT is able to improve diagnostic accuracy in a therapeutically relevant way in patients with iodine-negative DTC. By precisely localizing tumor tissue, image fusion by integrated PET/CT is clearly superior to side-by-side interpretation of PET and CT images.

Key Words: integrated PET/CT • differentiated thyroid cancer • ¹⁸F-FDG PET • Hürthle cell tumor • iodine negative

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