201Tl-chloride, which has a metabolic behaviour similar to that of potassium and cesium, has been used in 68 patients for the evaluation of thyroid nodules previously recognized as "cold" on 131I or 99mTc scans. All patients were re-examined with gamma-camera and/or sequential scintigraphic recordings during 60 min after i.v. administration of thallium. In some cases, simultaneous imaging and integral digital plot with 131I or 99mTc and 201Tl were performed. In all 12 malignant nodules, 201 Tl has showed a high uptake, while it did not concentrate in 47 benign nodules (cystic or macrofollicular adenomas); thallium uptake was nevertheless found in 10 solid neoformations in which histological pictures were negative for malignancy or atypical lesions. The computerized study of the 201Tl intranodular concentration, with the analysis of its dynamic function curves, seems to offer further possibility in differentiating and in a more objective evaluation of the "cold" areas on the thyroid scan.

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Because of its physical and potassium-metabolic characteristics 201T1 is more suitable than 131Cs for radioisotopic studies of the cold thyroid nodule, with the further diagnostic possibility of quantitatively assessing intranodular behaviour for a specific differentiation among different kinds of neoformations. Using a gamma-camera on line with a computer data processing device, sequential scintiscans were recorded for the first 20-30 min after i. v. administration of 15-20 MCi\lkg of radiothallium; delayed sequences were taken at 40-60 min if intranodular uptake appeared. A quantitative appraisal was made of the differential 201Tl uptake-ratio between nodule and healthy thyroid tissue (density-index) and the multiparameter analysis of thyroid time/activity curves generated on the relative regions of interest (ROIs). This computerized study, in 120 out of 293 patients submitted to this radiothallium test, has shown a) diagnostic agreement between clinical-histological and radioisotopic findings in 76 out of 79 colloid-cystic or degenerative neoformations, in all 16 malignant and in 23 out of 25 hyperplastic benign nodules; b) significant statistical difference of the density-index in solid versus cystic but not between benign and malignant nodules; c) different 201T1 kinetics behaviour in different kinds of solid thyroid lesions with a satisfactory statistical difference of the radiothallium nodular dissapearance-index.