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

Holger Palmedo, MD1, Jan Bucerius, MD1, Alexius Joe, MD1, Holger Strunk, MD2, Niclas Hortling, MD2, Susanne Meyka, MD1, Roland Roedel, MD, PhD1, Martin Wolff, MD3, Eva Wardelmann, MD4, Hans-Juergen Biersack, MD1 and Ursula Jaeger, MD2

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


Figure 1
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  		FIGURE 1.  A 56-y-old patient (Hürthle cell pT2 N0 M0, previous lymph node recurrence), with elevated TG level and no iodine accumulation, who showed pathologic 18F-FDG uptake in the right lower cervical region (A). Corresponding CT slices did not reveal any abnormality (B). PET/CT images (C) clearly showed that the PET finding was located on the right vocal cord and corresponded to benign, muscular uptake. No surgery was scheduled and follow-up confirmed this benign finding.

 

Figure 2
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  		FIGURE 2.  A 58-y-old patient (oxyphilic, follicular, pT3 N0 M0 G2), who had undergone total thyroidectomy and ablative radioiodine treatment 2 y earlier, presented with markedly elevated TG level but without any iodine accumulation. Sonography-guided fine-needle aspiration biopsy of a suggestive cervical lymph node revealed cells suggestive of tumor. Preoperative PET showed intense 18F-FDG uptake in the suspected, left cervical lymph node as demonstrated on the coronal slice (A). However, PET detected a second tumor focus that was located more caudally. For this second tumor, shown on the transverse PET slice (B), no corresponding abnormality could be localized on CT images (C). Only by fusion of PET and CT images (D) could the second lesion be precisely identified (located between esophagus and dorsolateral trachea) and be removed surgically. Histopathology revealed a 5-mm lymph node metastasis. At 2 y after surgery, the patient had no tumor recurrence.

 

Figure 3
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  		FIGURE 3.  Algorithm for clinical use of integrated PET/CT with 18F-FDG in DTC patients. FNA = fine-needle aspiration; WBSc = whole-body scintigraphy.

 

Figure 4
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  		FIGURE 4.  Alternative to PET/CT following the algorithm in Figure 3.

 




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