PT - JOURNAL ARTICLE AU - Daniela Schmidt AU - Attila Szikszai AU - Rainer Linke AU - Werner Bautz AU - Torsten Kuwert TI - Impact of <sup>131</sup>I SPECT/Spiral CT on Nodal Staging of Differentiated Thyroid Carcinoma at the First Radioablation AID - 10.2967/jnumed.108.052746 DP - 2009 Jan 01 TA - Journal of Nuclear Medicine PG - 18--23 VI - 50 IP - 1 4099 - http://jnm.snmjournals.org/content/50/1/18.short 4100 - http://jnm.snmjournals.org/content/50/1/18.full SO - J Nucl Med2009 Jan 01; 50 AB - The purpose of this study was to determine the diagnostic value of 131I SPECT/spiral CT (SPECT/CT) on nodal staging of patients with thyroid carcinoma at the first ablative radioiodine therapy. Methods: Fifty-seven patients were studied using SPECT/CT 3–4 d after receiving 3.96 ± 0.5 GBq of 131I for radioablation of thyroid remnants after a thyroidectomy for differentiated thyroid carcinoma. In addition to planar whole-body scintigraphy, SPECT/CT of the neck was performed using a hybrid camera combining a double-head SPECT camera with either a 2-slice (n = 23) or a 6-slice (n = 34) spiral CT scanner. The planar scans and the SPECT/CT images were evaluated for cervical tracer uptake independently of each other and of the clinical findings. Results: SPECT/CT led to a revision of the original diagnosis in 28 of 143 cervical foci of radioiodine uptake seen on planar imaging. In particular, SPECT/CT reclassified as benign 6 of 11 lesions considered to be lymph node metastases and 11 of 15 lesions considered to be indeterminate. Furthermore, SPECT/CT allowed the identification of 11 lymph node metastases classified as thyroid remnant or as indeterminate on planar imaging. Based on this revision, SPECT/CT yielded a gain in information on nodal stage in 20 of the 57 patients studied (35%, P &lt; 0.03). SPECT/CT altered nodal stage from N0 to N1 in 2 of 20 patients and from indeterminate (Nx) to N1 in 6 of 30 patients. The result was a change in risk stratification conforming to the classification proposed by the International Union Against Cancer in 14 patients (25%). Conclusion: SPECT/CT determines lymph node involvement at radioablation performed for thyroid cancer more accurately than does planar imaging. SPECT/CT may alter management in roughly one quarter of patients with thyroid carcinoma by upstaging or downstaging their disease.