Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma

Tharp, Kenneth; Israel, Ora; Hausmann, Johannes; Bettman, Lise; Martin, William H.; Daitzchman, Marcelo; Sandler, Martin P.; Delbeke, Dominique

doi:10.1007/s00259-004-1565-2

Cited by 170 publications

(97 citation statements)

References 6 publications

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“…diagnostic value, compared with planar imaging, in 57% of the 71 patients with thyroid carcinoma in a retrospective study (22). At the same time, Ruf et al performed a prospective study and concluded that the addition of SPECT/CT improved the interpretation of inconclusive 131 I findings on planar scans after ablative radiotherapy (23).…”

Section: Discussionmentioning

confidence: 99%

Incremental Value of ¹³¹I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

Chen¹,

Luo²,

Shen³

et al. 2008

J Nucl Med

139

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131 I whole-body scintigraphy (WBS) is a highly sensitive method for the detection of differentiated thyroid tumors and metastases. However, a lack of anatomic landmarks and the physiologic accumulation of the tracer complicate interpretation of the images. This prospective study was designed to evaluate the incremental value of 131 I SPECT/CT over planar WBS in the management of patients with differentiated thyroid carcinoma (DTC). Methods: Planar imaging was performed on 66 consecutive DTC patients who were considered to have locally advanced or metastatic disease after total or nearly total thyroidectomy. SPECT/CT was added for patients whose planar findings were inconclusive. The planar images were interpreted by 2 experienced nuclear medicine physicians. Interpretation of the SPECT/CT images was a consensus opinion of one of the nuclear medicine physicians and an experienced radiologist. Fusion images were considered to improve image interpretation when they better localized sites of increased 131 I uptake. The final diagnosis was verified by pathologic findings, other imaging modalities, and clinical follow-up. Both site-based and patient-based analyses were performed, and the impact of SPECT/CT results on therapeutic strategy was assessed. Results: A total of 232 foci were observed by 131 I WBS, including 33.2% of foci localized in the thyroid bed, 62.1% due to malignant lesions, and 4.7% caused by nonthyroidal physiologic or benign uptake or a contaminant. Overall, 37 SPECT/CT studies were performed on 23 patients, whose planar images showed 81 inconclusive lesions. Precise localization and characterization of 131 I-avid foci were achieved through 131 I SPECT/CT in 69 (85.2%) and 67 (82.7%) of the 81 foci, respectively. Fusion images were considered to be of benefit in 17 (73.9%) of 23 patients. The therapeutic strategy was changed in 8 (47.1%) of 17 patients. Uncommon metastatic lesions were found in 9 (13.6%) of 66 patients with regard to SPECT/CT fusion images. Conclusion: Fusion of SPECT and CT images was of incremental value over WBS in increasing diagnostic accuracy, reducing pitfalls, and modifying therapeutic strategies in 73.9% of DTC patients. As SPECT/CT techniques emerge, 131 I SPECT/CT may demonstrate higher value than WBS in the management of DTC.

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Section: Discussionmentioning

confidence: 99%

Incremental Value of ¹³¹I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

Chen¹,

Luo²,

Shen³

et al. 2008

J Nucl Med

139

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“…These datasets are typically displayed with cursor control so that they can easily be reviewed by the interpreting physician. Current clinical experiences have shown that the use of SPECT/CT provides the interpreting physician with a higher level of confidence in providing diagnostic information, and the presence of anatomic data from CT in fused images typically adds diagnostic information in 30%-35% of the cases, with even higher contributions in specific disease processes (11).…”

Section: Spect/ctmentioning

confidence: 99%

SPECT/CT Physical Principles and Attenuation Correction

Patton¹,

Turkington²

2008

Journal of Nuclear Medicine Technology

165

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Using nuclear medicine techniques, physiologic activity and processes can be identified in a way that is unique from other modalities. Oftentimes it is helpful to know the exact location of the physiologic uptake that is visualized on a scan. Knowing the exact location can sometimes help to distinguish normal from abnormal physiologic uptake. When an abnormality has been identified, knowing the exact location can then be helpful in treatment planning. The ability to provide precise localization of physiologic data from nuclear medicine studies is now possible with hybrid SPECT/CT systems. Additionally, these systems provide an accurate attenuation correction of the nuclear medicine image data. After reading this article, the technologist will be able to list and describe the inherent problems associated with SPECT image acquisition and reconstruction, briefly explain how data acquired from the CT scanner are used to provide attenuation correction data for SPECT and anatomic information for diagnostic purposes, list and briefly describe the different types of clinical SPECT/CT systems, and discuss the importance of accurate CT and SPECT image registration. For many years, physicians have been faced with the dilemma of identifying a region of increased uptake on a nuclear medicine image and then trying to determine the precise anatomic location of the region. This is of initial importance in differentiating between abnormal uptake and normal physiologic uptake. Once the determination of abnormal uptake has been established, then it is important for physicians to know the exact anatomic location of the region to determine the proper course of therapy. Recent advances in imaging technology have provided physicians with a new and powerful tool to handle this dilemma: integrated SPECT/CT systems. This work was pioneered by Lang and Hasagawa et al. (1), who not only combined hardware components into an integrated system but also developed important algorithms for SPECT attenuation correction using CT images. This technology makes it possible to acquire physiologic and anatomic images in a registered format and fuse them so that precise anatomic localizations of radiopharmaceutical distributions can readily be visualized. An additional benefit of this technologic advance is that the anatomic images can be used to perform high-quality attenuation corrections of the radiopharmaceutical distributions. To properly acquire these registered images and identify potential pitfalls in the process, it is necessary to have a good working knowledge of the physical principles and instrumentation involved in the data acquisition and image reconstruction processes. SPECTData required for constructing images using the techniques of SPECT are acquired by collecting planar images (typically in 64 · 64 or 128 · 128 data-point arrays) at multiple angles around the patient using single-, dual-, or triple-head scintillation cameras typically equipped with parallel-hole collimators, which provide projection views of the radioactivity from tho...

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“…Tharp and cols. (5) found that the use of this hybrid imaging combination contributed to the immediate management of thyroid cancers in 25% of cases. It is usually not essential to have full diagnostic quality CT images to accurately place the uptake.…”

Section: Discussionmentioning

confidence: 99%

Incidental finding of ovarian teratoma on post-therapy scan for papillary thyroid cancer and impact of SPECT/CT imaging

Jammah

Driedger

Rachinsky

2011

Arq Bras Endocrinol Metab

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A 41-year old woman post thyroidectomy and neck dissection is presented in this case. She initially presented goiter and an enlarged cervical lymph node. She had no family history of cancer or radiation therapy. She had total thyroidectomy and found to have papillary thyroid cancer (T4N1M0). Histopathology report revealed multifocal classical papillary thyroid carcinoma with lympho-vascular invasion, extra-thyroidal extension, and positive lymph nodes. She was treated with 6.5 Gigabecquerel (GBq) of 131Iodine. Whole-body scan showed uptake in the neck and large focus in the left lower abdomen. Single-photon emission computed tomography SPECT/CT demonstrated a round shaped mass in the left pelvis. Pathology revealed cystic teratoma with benign thyroid tissue (struma ovarii), and no malignancy. Two months later, she had the second treatment with 5.5 GBq 131Iodine. Her follow-up stimulated and non-stimulated thyroglobulin levels were significantly lower, and there was no abnormal uptake in the follow-up scan.

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Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma

Cited by 170 publications

References 6 publications

Incremental Value of ¹³¹I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

Incremental Value of ¹³¹I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

SPECT/CT Physical Principles and Attenuation Correction

Incidental finding of ovarian teratoma on post-therapy scan for papillary thyroid cancer and impact of SPECT/CT imaging

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Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma

Cited by 170 publications

References 6 publications

Incremental Value of 131I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

Incremental Value of 131I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

SPECT/CT Physical Principles and Attenuation Correction

Incidental finding of ovarian teratoma on post-therapy scan for papillary thyroid cancer and impact of SPECT/CT imaging

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Product

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Incremental Value of ¹³¹I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma

Incremental Value of ¹³¹I SPECT/CT in the Management of Patients with Differentiated Thyroid Carcinoma