Abstract
Recently, technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) has been used to image thyroid carcinoma. A prospective study was performed to compare the efficacy of99mTc-MIBI to thallium-201 (201T1) scintigraphy in patients with differentiated thyroid carcinoma. The clinical utility of all radionuclide imaging modalities, i.e.,99mTc-MIBI,201Tl, and iodine-131 Na (131I-Na), as well as serum thyroglobulin estimation, was evaluated. Thirty-four post-thyroidectomy patients (age range: 26–76 years) underwent 45 studies. Histopathologies studied included fourteen papillary, eight papillaryfollicular, ten follicular, one Hürthle cell, and one medullary carcinoma of the thyroid. Following optimal stimulation of endogenous thyroid stimulating hormone (i.e, TSH >-50 mU/ml), the patients underwent201Tl and99mTc-MIBI scintigraphy. Concomitant131I-Na scintigraphy was performed and serum thyroglobulin levels were measured. Sixteen scan sets were performed prior to131I-Na ablation therapy. Twenty-nine scan sets were performed following131I-Na ablation therapy. The presence or absence of thyroid cancer was established by clinical, biochemical, radiologic, and/or biopsy findings. There was no significant difference in sensitivity and specificity of201Tl scintigraphy versus99mTc-MIBI scintigraphy in pre- and postablation studies.131I-Na scintigraphy with determination of thyroglobulin level was sufficient in preablation studies. Among postablation patients, the addition of99mTc-MIBI or201Tl offered a higher diagnostic yield. Between the201Tl and99mTc-MIBI studies, there was a concordance of 69% in preablation and 97% among postablation patients (P=0.027). It is concluded that99mTc-MIBI is a suitable alternative to201Tl scintigraphy in thyroid carcinoma, especially following thyroidectomy and131I-Na therapy.131I-Na scintigraphy with serum thyroglobulin is adequate in both pre- and postablation patients. Among the post-131I-Na ablation patients,99mTc-MIBI or201Tl is extremely valuable for tumor localization, especially when the131I-Na whole-body scan is negative. The combination of99mTc-MIBI or201Tl scintigraphy with131I-Na and serum thyroglobulin offers the highest diagnostic yield.
Similar content being viewed by others
References
Müller S, Guth-Tougelides B, Creutzig H. Imaging of malignant tumors with99mTc-MIBI spect [abstract].J Nucl Med 1987; 28: 562.
Aktolun C, Bayhan H, Kir M. Clinical experience with99mTc-MIBI imaging in patients with malignant tumors: preliminary results and comparison with201thallium.Clin Nucl Med 1992; 17: 171–176.
Briele B, Hotze A, Kropp J, et al. A comparison of201Tl and99mTc-MIBI in the follow-up of differentiated thyroid carcinoma.Nuklearmedizin 1991; 30: 115–124.
Maurea S, Lastoria S, Main M, et al.99mTechnetium-MIBI scan in the initial evaluation and post-surgical follow-up of thyroid cancer [abstract].J Nucl Med 1994; 35: 167P.
Balone HR, Fink-Bennett D, Stoffer SS.99mTechnetium-sestamibi uptake by recurrent Hürthle cell carcinoma of the thyroid.J Nucl Med 1992; 33: 1393–1395.
O'Driscoll CM, Baker F, Casey MJ, Duffy GJ. Localization of recurrent medullary thyroid carcinoma with99mtechnetiummethoxyisobutylnitrile scintigraphy: a case report.J Nucl Med 1991: 32: 2281–2283.
Scott AM, Kostakoglu L, O'Brien JP, Straus DJ, Abdel-Dayem HM, Larson SM. Comparison of99mtechnetium-MIBI and201thalluim chloride uptake in primary thyroid lympboma.J Nucl Med 1992; 33: 1396–1398.
Davis M. The current and future use of tumor-localizing agent [editorial].J Nucl Med 1990; 31: 1656
Kao C, Lin W, Wang S, Yeh S. Visualization of suppressed thyroid tissue by99mTc-MIBI.Clin Nucl Med 1991; 16: 812–814.
Briele B, Hotze A, Kropp J, et al. Vergleich von201Tl und99mTc-MIBI in der Nachsorge des differenzierten Schilddriisenkarzinoms.Nucl Med 1991; 30: 115–124.
Mueller SP, Piotrowski B, Guth-Tougelides B, Reiners C.99mTc-MIBI and201Tl uptake in thyroid carcinoma [abstract].J Nucl Med 1988; 29: 854.
Dadparvar S, Krishna L, Brady LW, et al. The role of131iodine-Na and201thallium imaging and serum thyroglobulin in the management of differentiated thyroid carcinoma.Cancer 1993; 71: 3767–3773.
Ramanna L, Waxman A, Braunstein G.201Thallium scintigraphy in differentiated thyroid cancer: comparison with radioiodine scintigraphy and serum thyroglobulin determinations.J Nucl Med 1991; 32: 441–446.
Katagiri M, Suzuki S, Sadahiro S, et al. Accumulation of131iodine and99mtechnetium pertechnetate in thyroid carcinomaClin Nucl Med 1988; 13: 276–279.
Bouvier J-F, You E, Peau J-Y, Chasard J-L, Lahneche B-E. Diffuse uptake of99mtechnetium pertechnetate in a patient with metastases from thyroid carcinoma.Clin Nucl Med 1986; 11: 728–729.
Foldes I, Levay A, Stotz G. Comparative scanning of thyroid nodules with99mtechnetium pertechnetate and99mtechnetiummethoxyisobutylisonitrile.Eur J Nucl Med 1993; 20: 330–333.
Lastoria S, Vergara E, Varrella P, et al. Imaging of differentiated thyroid tumors with99mTc(V)DMSA [abstract].J Nucl Med 1993; 34: 12p.
Bigsby RJ, Lepp EK, Litwin DE, Wilkinson AA, Matte GG.99mTechnetium pentavalent dimercaptosuccinic acid and201thallium in detecting recurrent medullary carcinoma of the thyroid.Can J Surg 1992; 35: 388–392.
Hoefnagel CA, Delprat CC, Marcuse HR, de Vijlder JJM. Role of201thallium total body scintigraphy in follow-up of thyroid carcinoma.J Nucl Med 1986; 27: 1854–1857.
Delmon-Moingeon LI, Piwnica-Worms D, Van den Abbeele AD, et al. Uptake of the cation hexakis (2-methoxyisobutylisonitrile)99mtechnetium by human carcinoma cell lines in vitro.Cancer Res 1990; 50: 2198–2202.
Sundram FX, Goh AS, Ang ES. Role of99mtechnetium sestamibi in localisation of thyroid cancer metastases.Ann Acad Med Singapore 1993; 22: 557–559.
Wackers FIT, Berman DS, Maddahi J, et al.99mTechnetium hexakis 2-methoxyisobutyl isonitrile: human biodistribution, dosimetry, safety, and preliminary comparison to 2o1thallium for myocardial perfusion imaging.J Nucl Med 1989; 30: 301–311.
Savi A, Gerundini P, Zoli P, et al. Biodistribution of99mTcmethoxyisobutylisonitrile (MIBI) in humans.Eur J Nucl Med 1989; 15: 597–600.
Waxman AD. Non-cardiac uses of201Tl and99mTc-sestamibi. In:Clinical nuclear medicine. Harvard Medical School Annual Lectureship, 1994, p86–86d.
Kao CH, Wang SJ, Lin WY, et al. Differentiation of single solid lesions in the lungs by means of single photon emission tomograph with99mTc-methoxyisobutylisonitrile.Eur J Nucl Med 1993; 20: 249–254.
Hassan IM, Sahweil A, Constantinides C, et al. Uptake and kinetics of99mTc-hexakis 2-methoxyisobutylisonitrile in benign and malignant lesions in the lungs.Clin Nucl Med 1989; 14: 333–340.
Chiu ML, Kronauge JF, Piwnica-Worms D. Effect of mitochondria and plasma membrane potentials on accumulation of methoxyisobutylisonitrile technetium (I) in culture myoblasts.J Nucl Med 1990; 31: 1646.
Piwnica-Worms D, Holman BL. Noncardiac applications of hexakis-(alkylisonitrile)99mtechnetium complexes [editorial].J Nucl Med 1990; 31:1166–1167.
Author information
Authors and Affiliations
Additional information
This paper is based on a presentation at the 76th Annual Meeting of the American Radium Society, South Hampton, Bermuda, 22–26 April 1994.
Rights and permissions
About this article
Cite this article
Dadparvar, S., Chevres, A., Tulchinsky, M. et al. Clinical utility of technetium-99m methoxisobutylisonitrile imaging in differentiated thyroid carcinoma: comparison with thallium-201 and iodine-131 Na scintigraphy, and serum thyroglobulin quantitation. Eur J Nucl Med 22, 1330–1338 (1995). https://doi.org/10.1007/BF00801623
Issue Date:
DOI: https://doi.org/10.1007/BF00801623