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Combined metabolic and morphologic imaging in thyroid carcinoma patients with elevated serum thyroglobulin and negative cervical ultrasonography: role of 124I-PET/CT and FDG-PET

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

This study sought to compare iodine-124 positron emission tomography/computed tomography (124I-PET/CT) and 2-[18F]fluoro-2-deoxy-d-glucose- (FDG-) PET in the detection of recurrent differentiated thyroid carcinoma (DTC) lesions in patients with increasing serum thyroglobulin (Tg), Tg-antibodies, or both, but without pathological cervical ultrasonography. We assessed the lesion detection accuracy of 124I-PET alone, CT alone, 124I-PET/CT, FDG-PET, and all these modalities combined.

Material and methods

The study included 21 patients (9 follicular, 12 papillary DTC) who had been rendered disease-free by thyroidectomy and radioiodine treatment (RIT) and followed up for 21-275 months after the last RIT. In all patients, FDG-PET was performed first. Within 1 week, 124I-PET/CT was performed 24 h after oral administration of 43 ± 11 MBq 124I. Imaging results were correlated with further clinical follow-up with (n = 12) or without (n = 9) post-study histology as the reference standard.

Results

The sensitivities for DTC lesion detection were: 124I-PET, 49%; CT, 67%; 124I-PET/CT, 80%; FDG-PET, 70%; and all modalities combined, 91%. For local recurrences (distant metastases), the sensitivities were: 124I-PET, 60% (45%); CT, 20% (84%); and FDG-PET, 65% (71%). One-third of lesions demonstrated pathological tracer uptake with both 124I- and FDG-PET, while two-thirds were positive with only one of these modalities.

Conclusion

Used together, 124I-PET and CT allow localization of foci of highly specific 124I uptake as well as non-iodine-avid lesions. The combination of 124I-PET/CT and FDG-PET improves restaging in recurrent DTC by enabling detection on whole-body scans of local recurrence or metastases that are often not found if only one of the methods or other imaging modalities are applied.

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Acknowledgement

We are indebted to Robert J. Marlowe for critically reading and editing the manuscript.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University of Duisburg/Essen, Hufelandstrasse 55, 45122, Essen, Germany

    L. S. Freudenberg, W. Jentzen, S. J. Rosenbaum, A. Bockisch & R. Görges

  2. Department of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg/Essen, Essen, Germany

    G. Antoch & H. Kühl

  3. Department of General, Visceral and Transplantation Surgery, University of Duisburg/Essen, Essen, Germany

    A. Frilling

Authors
  1. L. S. Freudenberg
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  2. G. Antoch
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  3. A. Frilling
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  4. W. Jentzen
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  5. S. J. Rosenbaum
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  6. H. Kühl
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  7. A. Bockisch
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  8. R. Görges
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Correspondence to L. S. Freudenberg.

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Freudenberg, L.S., Antoch, G., Frilling, A. et al. Combined metabolic and morphologic imaging in thyroid carcinoma patients with elevated serum thyroglobulin and negative cervical ultrasonography: role of 124I-PET/CT and FDG-PET. Eur J Nucl Med Mol Imaging 35, 950–957 (2008). https://doi.org/10.1007/s00259-007-0634-8

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  • DOI: https://doi.org/10.1007/s00259-007-0634-8

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