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Journal of Nuclear Medicine

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Meeting ReportGeneral Clinical Specialties Track

18FDG PET/CT Delayed Scan in Diagnosis of Thyroid Disorders. Incidental Finding. Case Study.

FARID RISHEQ, SHUAA AL-SADOON and M.ZIAD ALRISHEQ
Journal of Nuclear Medicine May 2016, 57 (supplement 2) 1695;
FARID RISHEQ
1DR. FARID RISHEQ N M. PET/CT & BONE DENSITY CENTIR AMMAN Jordan
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SHUAA AL-SADOON
2NUCLEAR MEDICINE DR. FARID RISHEQ N M. PET/CT & BONE DENSITY CENTIR AMMAN Jordan
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M.ZIAD ALRISHEQ
1DR. FARID RISHEQ N M. PET/CT & BONE DENSITY CENTIR AMMAN Jordan
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Abstract

1695

Objectives To presents the clinical significance of focal increased 18F-FDG PET/CT uptake in delayed scans for differentiating benign from malignant thyroid disorders

Methods Two cancer female patients; a 68y old with Non-Hodgkin’s Lymphoma (NHL) of Maxilla, and a 54y old with papillary ovarian adenocarcinoma underwent 18F-FDG PET/CT scans; IV injection dose 300 MBq, and (7-8) bed/130sec. Early scan performed at 60-65 min., and delayed scan at 170-180 min. from 18F-FDG injection time. Early and delayed SUVmax of each lesion was determined and retention index (RI%) calculated: RI% = 100 x ( SUVmax delayed  - SUVmax early ) / SUVmax early

Results 18F-FDG PET/CT scan for the patient with NHL of Maxilla showed a focal hyper metabolic mass lesion in the left lung/mid zone posteriorly; and enlarged thyroid with multi nodular changes detected on CT scan. One lesion showed increased 18F-FDG metabolism with SUVmax early = 6.11. We further took a delayed image resulting in SUVmax delayed = 4.02; RI% = -34.2%. The patient was referred for thyroid function test: TSH = 2.4 IU/L; Tg < 10 ng/ml. The histopathology of US-guided FNA biopsy samples suggested thyroid multi nodular goiter of benign cells. The negative RI% value indicated that the benign lesion was unable to retain 18F-FDG inside its normal cells. 18F-FDG PET/CT scan for the patient with ovarian adenocarcinoma showed focal hyper metabolic lymph node lesion visible in the left lower posterior deep cervical region. Thyroid was enlarged, with focal nodules of irregular hyper metabolic 18F-FDG uptake in Lt lobe with SUVmax early = 12.57, SUVmax delayed = 16.28; and RI%=29.5. Thyroid Function Test was advised: TSH = 7.9 IU/L, Tg = 18.9 ng/ml, and final diagnosis was determined by thyroid tissue biopsy. The histopathology of US-guided FNA biopsy samples suggested Hashimoto’s thyroiditis and papillary carcinoma, classical type. The patient underwent total thyroidectomy. The positive RI% value indicated that malignant lesion retained 18F-FDG inside its abnormal cells.

Conclusions Positive RI% of incidentally detected thyroid lesion by 18F-FDG PET/CT delayed scan can be a sensitive tool to indicate malignancy. Further work is required to assure its utility as a complementary protocol for differentiating thyroid benign lesion from malignant lesions. 18F-PDG PET/CT computer software can be modified to project the differentiation.

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Journal of Nuclear Medicine
Vol. 57, Issue supplement 2
May 1, 2016
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18FDG PET/CT Delayed Scan in Diagnosis of Thyroid Disorders. Incidental Finding. Case Study.
FARID RISHEQ, SHUAA AL-SADOON, M.ZIAD ALRISHEQ
Journal of Nuclear Medicine May 2016, 57 (supplement 2) 1695;

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18FDG PET/CT Delayed Scan in Diagnosis of Thyroid Disorders. Incidental Finding. Case Study.
FARID RISHEQ, SHUAA AL-SADOON, M.ZIAD ALRISHEQ
Journal of Nuclear Medicine May 2016, 57 (supplement 2) 1695;
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