Quantitative dual isotope 123iodine/99mTc-MIBI scintigraphy: A new approach to rule out malignancy in thyroid nodules

Benderradji, Hamza; Beron, Amandine; Wémeau, Jean-Louis; Carnaille, B.; Delcroix, Laurent; Cao, Christine Do; Baillet, C.; Huglo, D.; Lion, Georges; Boury, S.; Cussac, Jean-Félix; Caïazzo, Robert; Pattou, François; Leteurtre, Emmanuelle; Vantyghem, Marie-Christine; Ladsous, M.

doi:10.1016/j.ando.2021.03.003

Cited by 9 publications

(3 citation statements)

References 31 publications

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“…Another dual-phase scintigraphy, namely dual tracer (99m-Tc and 123 Iodine), provides simultaneous images that avoid the subtraction-related artefacts and might prove beneficial in multi-glandular parathyroid disease in addition to thyroid gland-related infor-mation [31,32]. The traditional issues of blocked thyroid uptake after recent iodine exposure (as seen after using iodine contrast CT) or in individuals under chronic levothyroxine replacement therapy should be taken into consideration when using iodine scintigraphy [33].…”

Section: Imaging Pitfalls In Phpmentioning

confidence: 99%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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Diagnosis of primary hyperparathyroidism (PHP) is based on blood assessments in terms of synchronous high calcium and PTH (parathormone), but further management, particularly parathyroid surgery that provides the disease cure in 95–99% of cases, requires an adequate localisation of the parathyroid tumour/tumours as the originating source, with ultrasound and 99m-Technetium (99m-Tc) sestamibi scintigraphy being the most widely used. We aimed to introduce an adult female case diagnosed with PHP displaying unexpected intra-operatory findings (ectopic thyroid tissue) in relation to concordant pre-operatory imaging modalities (ultrasound + dual-phase 99m-Tc pertechnetate and sestamibi scintigraphy + computed tomography) that indicated bilateral inferior parathyroid tumours. A sudden drop in PTH following the removal of the first tumour was the clue for performing an extemporaneous exam for the second mass that turned out to be non-malignant ectopic thyroid tissue. We overviewed some major aspects starting from this case in point: the potential pitfalls of pre-operatory imaging in PHP; the concordance/discordance of pre-parathyroidectomy localisation modalities; the need of using an additional intra-operatory procedure; and the clues of providing a distinction between pathological parathyroids and thyroid tissue. This was a case of adult PHP, whereas triple localisation methods were used before parathyroidectomy, showing concordant results; however, the second parathyroid adenoma was a false positive image and an ectopic thyroid tissue was confirmed. The pre-operatory index of suspicion was non-existent in this patient. Hybrid imaging modalities are most probably required if both thyroid and parathyroid anomalies are suspected, but, essentially, awareness of the potential pitfalls is mandatory from the endocrine and surgical perspectives. Current gaps in imaging knowledge to guide us in this area are expected to be solved by the significant progress in functional imaging modalities. However, the act of surgery, including the decision of a PTH assay or extemporaneous exam (as seen in our case), represents the key to a successful removal procedure. Moreover, many parathyroid surgeons may currently perform 4-gland exploration routinely, precisely to avoid the shortcomings of preoperative localisation.

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Section: Imaging Pitfalls In Phpmentioning

confidence: 99%

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Carsote,

Stanciu,

Popa

et al. 2023

Medicina

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“…While TI-RADS provides objective risk assessment based on anatomic features for individual nodules, its recommendations may be modified by other available imaging features. For example, 'cold' hypofunctioning nodules with absence of uptake on thyroid scintigraphy (I-123 or Tc-99m pertechnetate) are classically associated with an increased risk of malignancy; increased late uptake on Tc-99m sestamibi (MIBI) scanning (uptake values >5.9) is a reproducible, potentially valuable method to identify cancer in the setting of prior indeterminate or nondiagnostic nodule cytology [25]. Incidental focal thyroid nodule uptake on positron emission tomography/computed tomography (PET/ CT) indicates an increased risk of malignancy [26].…”

Section: Key Pointsmentioning

confidence: 99%

Advanced imaging and theranostics in thyroid cancer

Roseland

Dewaraja

Wong

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewThyroid cancers are endocrine neoplasms with diverse gene expression and behavior, for which constantly evolving anatomic and functional imaging/theranostic agents have an essential role for diagnosis, staging, and treatment. Recent findingsTo achieve definitive diagnosis, neck ultrasound and associated risk stratification systems, notably Thyroid Imaging Reporting and Data System (TI-RADS), allow improved thyroid nodule characterization and management guidance. Radioactive iodine-131 (RAI) has long played a role in management of differentiated thyroid cancer (DTC), with recent literature emphasizing its effectiveness for intermediate-high risk cancers, exploring use of dosimetry for personalized medicine, and potential for retreatment with RAI following tumor redifferentiation. Iodine-124 positron emission tomography/computed tomography (PET/ CT) has promising application for DTC staging and dosimetry. F18-fluorodeoxyglucose (FDG) PET/CT is used for staging of high risk DTC and identification of noniodine-avid disease recurrences, with metabolic uptake consistently portending poor prognosis. Poorly differentiated and anaplastic thyroid cancers are best assessed with anatomic imaging and F18-FDG PET/ CT, though recent studies show a potential theranostic role for Ga68/Lu177-prostate-specific membrane antigen. Medullary thyroid cancers are evaluated with ultrasound, CT, magnetic resonance imaging, and various positron-emitting radiotracers for PET imaging (F18-DOPA, F18-FDG, and recently Ga68-1,4,7,10-tetraazacyclododecane-1,4,7,10tetraacetic acid (DOTA)--octreotate (DOTATATE)); the latter may enable treatment with Lu177-DOTATATE. SummaryMultidisciplinary collaboration is essential to streamline appropriate management, given the wide array of available imaging and new therapies for metabolic and genetically complex cancers.

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“…Количественная оценка интранодулярного накопления РФП существенно снижает роль субъективного фактора. Результат слепой оценки двумя врачами, основанный на предварительном расчете порогового значения индекса ретенции РФП на поздней фазе исследования, показал очень высокие значения коэффициентов внутригрупповой корреляции при дифференциации доброкачественных (0,94) и злокачественных (0,85) поражений [43]. Использование количественной сцинтиграфии с МИБИ наиболее информативно при неопределенных результатах ТАБ (категории 3 и 4 по Bethesda Thyroid Classification, 2009 г.…”

Section: метаболический скрининг узлов щитовидной железыunclassified

Scintigraphy in Thyroid Nodular Pathology

Mironov

Сергиенко

2022

Vestn. rentgenol. radiol.

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Thyroid scintigraphy is a method that formed more than 60 years ago and retains its importance for the diagnosis and assessment of the risk of nodular malignancy. The review examines the use of the scintigraphic method in functional and metabolic assessment of nodular goiter. Prerequisites for functional thyroid nodes screening with short-lived 99mTc-pertechnetate are outlined. Information is provided on the principles of its preparation and pharmacokinetics, as well as variants of the thyroid nodes functional activity, their possible malignant potential and indications for metabolic screening. The characteristic of metabolic activity allows to assess the risk of functionally “cold” thyroid nodes malignancy. The main stages of the use of nonspecific tumorotropic radiopharmaceuticals, the mechanism of their accumulation and metabolism in the thyroid tumors, the possibilities of the differential diagnosis of various types of nodular formations are presented. Modern views on the diagnostic capabilities of two-phase scintigraphy with 99mTс-methylisobutylisonitrile are reflected taking into account the relationship of radiopharmaceuticals accumulation with factors of proliferative activity and ultrastructural cell types, a variant of oncocytic pathology and multidrug-resistant protein expression.

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Quantitative dual isotope 123iodine/99mTc-MIBI scintigraphy: A new approach to rule out malignancy in thyroid nodules

Cited by 9 publications

References 31 publications

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Pitfalls of DualTracer 99m-Technetium (Tc) Pertechnetate and Sestamibi Scintigraphy before Parathyroidectomy: Between Primary-Hyperparathyroidism-Associated Parathyroid Tumour and Ectopic Thyroid Tissue

Advanced imaging and theranostics in thyroid cancer

Scintigraphy in Thyroid Nodular Pathology

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