The FUSION iENA Study: Comparison of I-124-PET/US Fusion Imaging with Conventional Diagnostics for the Functional Assessment of Thyroid Nodules by Multiple Observers

Winkens, Thomas; Seifert, Philipp; Hollenbach, C; Kühnel, Christian; Gühne, Falk; Freesmeyer, Martin

doi:10.1055/a-1031-9832

Cited by 14 publications

(18 citation statements)

References 36 publications

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“…Patient data of a previous study, named “ F usion U ltra S ound I maging o f the Thyroid Gla N d with I -124 PET— E valuation of N odule A llocation. ( FUSION iENA )” were further evaluated [ 28 ]. Adult patients who were referred to a university hospital for clinical routine thyroid diagnostics between February 2015 and February 2017 and, who gave informed consent for additional I-124-PET/US fusion imaging in case of uncertain findings in conventional diagnostics (CD) and for the usage of their data for future research, were included.…”

Section: Methodsmentioning

confidence: 99%

“…In order to overcome this limitation and to achieve accurate functional characterizations of TN, hybrid imaging approaches such as sensor-navigated Tc-99m-pertechnetate single photon emission computed tomography (SPECT)/US and sensor-navigated sodium iodine-124 (I-124) positron emission tomography (PET)/US have been introduced [ 24 , 25 , 26 , 27 ]. Particularly, I-124-PET/US proved to be superior in comparison to the conventional diagnostics (CD), comprising B-mode US and Tc-99m-pertechnetate scintigraphy, in a multi-observer study with >100 nuclear medicine physicians [ 28 ]. The results of this study showed that the confidence in functional assessment of TN increases significantly when I-124-PET/US is added to CD.…”

Section: Introductionmentioning

confidence: 99%

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Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students

Freesmeyer

Winkens

Weissenrieder

et al. 2020

Sensors

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In conventional thyroid diagnostics, the topographical correlation between thyroid nodules (TN) depicted on ultrasound (US) in axial or sagittal orientation and coronally displayed scintigraphy images can be challenging. Sensor-navigated I-124-PET/US fusion imaging has been introduced as a problem-solving tool for ambiguous cases. The purpose of this study was to investigate the results of multiple unexperienced medical students (MS) versus multiple nuclear medicine physicians (MD) regarding the overvalue of I-124-PET/US in comparison to conventional diagnostics (CD) for the functional assessment of TN. Methods: Out of clinical routine, cases with ambiguous findings on CD were selected for I-124-PET/US fusion imaging. Sixty-eight digital patient case files (PCF) of 34 patients (CDonly and CD+PET/US PCF) comprising 66 TN were provided to be retrospectively evaluated by 70 MD and 70 MS, respectively. A total of 2174 ratings (32.9 per TN) were carried out: 555 ratings (8.4 per TN) for CDonly and 532 ratings (8.1 per TN) for CD+PET/US by each MD and MS. Results: Functional assessment revealed 8.5%/11.7% (n.s.) (16.4%/25.8% (p = 0.0002)), 41.8%/28.5% (p < 0.0001) (23.9%/17.9% (p = 0.0193)), 36.0%/30.5% (n.s.) (57.3%/53.9% (n.s.)), and 13.7%/29.4% (p < 0.0001) (2.4%/2.4% (n.s.)) hyperfunctioning, indifferent, hypofunctioning, and not rateable TNs for CDonly (CD+PET/US) and MD/MS, respectively. The respective rating confidence was indicated as absolute certain, quite certain, equivocal, uncertain, and not rateable in 11.7/3.4% (p < 0.0001) (44.9%/38.9% (p = 0.0541), 51.9%/26.7% (p < 0.0001) (46.2%/41.5% (n.s.)), 21.6%/29.0% (p = 0.0051) (6.2%/14.8% (p < 0.0001)), 1.1%/11.5% (p < 0.0001) (0.2%/2.3% (p = 0.0032)), and 13.7%/29.4% (p < 0.0001) (2.4%/2.4% (n.s.)) by MD/MS, respectively. There was a significant difference in the diversity of the observers’ functional assessment of TN (MD 0.84 vs. MS 1.02, p = 0.0006) and the respective confidence in functional assessment (MD 0.93 vs. MS 1.16, p < 0.0001) between MD and MS on CDonly, whereas CD+PET/US revealed weaker differences for both groups (MD 0.48 vs. MS 0.47, p = 0.57; and MD 0.66 vs. MS 0.83, p = 0.0437). With the additional application of I-124-PET/US, the rating diversity of both MD and MS markedly tends towards more consistency (p < 0.0001 in each case). Conclusion: The additional application of sensor-navigated I-124-PET/US fusion imaging significantly influenced the functional assessment of TN positively, especially for unexperienced observers.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students

Freesmeyer

Winkens

Weissenrieder

et al. 2020

Sensors

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“…In der FUSION iENA Studie aus dem Jahr 2019 [51] Die bisherigen Studienergebnisse anhand einer Auswahl von 34 Patienten mit schwieriger topografischer Korrelation von sonografisch identifizierten Schilddrüsenknoten mit dem Szintigramm zeigen, dass insbesondere der Anteil von hypofunktionellen, aber auch der kleiner hyperfunktioneller Knoten in der konventionellen Diagnostik unterschätzt zu sein scheint. Zudem bestehen v. a. bei ungünstig lokalisierten Knoten (z.…”

Section: Spectunclassified

“…B. randständig oder dorsal im Schilddrüsenparenchym) häufig Unsicherheiten hinsichtlich der szintigrafischen Charakterisierung, was zu einer relevanten Interobserver-Variabilität führen kann. Hinsichtlich der genannten Limitationen zeigten sich hochsignifikant bessere Ergebnisse, wenn eine ergänzende [ 124 I]-PET/US-Fusionsbildgebung durchgeführt wurde [51,52]. So konnten z.…”

Section: Spectunclassified

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Die „Standard“-Schilddrüsenszintigrafie – ist sie noch zeitgemäß?

Görges

Bockisch

Seifert

2020

Der Nuklearmediziner

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ZusammenfassungAus fachfremder Sicht wird der Stellenwert der „konventionellen“ Schilddrüsenszintigrafie zur Klärung diverser thyreologischer Fragestellungen international mittlerweile weit niedriger eingeschätzt, als dies dem hierzulande tätigen Nuklearmediziner bewusst ist. Dieser Aufsatz gibt einen Überblick über häufig geäußerte Kritikpunkte an der Schilddrüsenszintigrafie und möchte einiges hierzu klarstellen sowie in berechtigten Fällen fundierte Gegenargumente liefern. In diesem Rahmen wird ein Überblick über die weiterhin bestehenden Indikationen gegeben, es werden aber auch Aspekte angeschnitten, bei denen Verbesserungsbedarf besteht. Abschließend erfolgt eine Aussicht auf zukünftige Perspektiven und Weiterentwicklungen der funktionellen Charakterisierung von thyreoidalem Gewebe.

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Integrated Thyroid Imaging: Ultrasound and Scintigraphy

Schenke

Groener

Grunert³

et al. 2023

Integrated Diagnostics and Theranostics of Thyroid Diseases

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Thyroid sonography has made substantial progress over the last decades in terms of spatial resolution and additional parameters including vascularity, perfusion, and elasticity of lesions. The improved depictability of thyroid nodules has led to a more detailed sonographic characterization of malignant thyroid nodules considering features like microcalcification, capsular invasion, and reduced elasticity. Thus, ultrasound (US) has become the most important single tool for risk assessment of thyroid nodules. Predominantly cystic and spongiform nodules as well as many nodules with a mixed composition of solid and cystic components can safely be identified as benign on ultrasound and need no further work-up for risk assessment. Predominantly solid nodules, however, require a structured and consistent sonographic assessment including the evaluation of nodule composition, echogenicity, calcifications, shape, margins, and additional sonographic parameters. One should adhere to one of the TIRADS when reporting ultrasound findings on thyroid nodules categorizing each nodule to a certain risk class. However, the risk of malignancy reported in studies for each class may not be readily transferrable to daily routine, since the prevalence of malignant nodules in tertiary care centers is as high as 20% whereas in primary care units the prevalence may be as low as 1 per mille, thus lowering positive predictive values by one to two orders of magnitude. In addition, some suspicious features found in those studies may not be directly transferable to daily practice: microcalcifications are often difficult to discern from benign colloidal spots, even after having run through learning sessions; a taller-than-wide shape of nodules with contact to the dorsal parts of the thyroid gland does not imply malignancy according to a pole concept which has been recently developed.Thyroid scintigraphy (TS) has long been an indispensable modality for functional characterization of thyroid nodules. It should be applied to rule out malignancy in a substantial proportion of predominantly solid nodules by showing a hyperfunctioning (“hot”) nodule. Such nodules are almost always benign with few exceptions (e.g., “trapping only” nodules). If laboratory findings and scintigraphic appearance of a hot nodule do not match, further diagnostic work-up is warranted including 123I− scintigraphy with late imaging at 24 h and fine-needle aspiration cytology (FNAC). In settings with a rather low prevalence of malignant thyroid nodules such as in primary or secondary care units, a combined use of US and TS may be adopted to rule in suspicious nodules for further work-up by FNAC, including predominantly solid hypofunctioning (“cold”) nodules. MIBI scintigraphy can be used in hypofunctioning nodules with indeterminate cytology and if contraindications preclude patients from FNAC.TS is a valuable tool to detect functional abnormalities not only in nodules but also in the thyroid gland as a whole by assessing the overall radionuclide uptake. As such, it has long been used to confirm the diagnosis of Graves’ disease and thyroid autonomy. For disseminated autonomy, it is the only tool to definitely verify the diagnosis. In destructive thyroiditis, TS reliably shows a reduced overall radionuclide uptake justifying its application in selected cases with doubtful sonographic or laboratory findings. The user of TS is encouraged to calculate a site-specific normal range for the uptake value normalized to TSH in addition to the raw uptake. Thus, even subtle functional disorders of the thyroid can be detected and graded.Functional or metabolic imaging is increasingly combined with morphological imaging and is acquired and displayed as volume data rather than planar images including SPECT/CT, PET/CT, and PET/MRI. These combined modalities increase the restricted morphological field of view from ultrasound enabling to reliably image substernal, ectopic, or dystopic localizations of thyroid tissue. Combined modalities also benefit from the increasing spectrum of functional or metabolic tracers including MIBI, iodine isotopes (e.g., 124I-) and newer PET tracers.

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The FUSION iENA Study: Comparison of I-124-PET/US Fusion Imaging with Conventional Diagnostics for the Functional Assessment of Thyroid Nodules by Multiple Observers

Cited by 14 publications

References 36 publications

Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students

Fusion iENA Scholar Study: Sensor-Navigated I-124-PET/US Fusion Imaging versus Conventional Diagnostics for Retrospective Functional Assessment of Thyroid Nodules by Medical Students

Die „Standard“-Schilddrüsenszintigrafie – ist sie noch zeitgemäß?

Integrated Thyroid Imaging: Ultrasound and Scintigraphy

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