Download PDF
Der Nuklearmediziner 2004; 27(4): 272-277
DOI: 10.1055/s-2004-832475
© Georg Thieme Verlag Stuttgart · New York

PET/CT - Stellenwert beim Schilddrüsenkarzinom

Value of PET/CT in Thyroid CarcinomaS. Rosenbaum1 , L. Freudenberg1 , R. Pink1 , K. Brandt-Mainz3 , S. Müller1 , G. Antoch2 , H. Kühl2 , R. Görges1 , A. Bockisch1
  • 1Klinik für Nuklearmedizin, Universität Duisburg/Essen
  • 2Institut für diagnostische und interventionelle Radiologie, Universität Duisburg/Essen
  • 3Gemeinschaftspraxis Radiologie/Nuklearmedizin, Essen
Further Information

Publication History

Publication Date:
14 February 2005 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Für die drei histologischen Hauptentitäten des Schilddrüsenkarzinoms: anaplastisches, medulläres (MTC) und von den Follikelzellen (FTC) ausgehendes Karzinom, hat sich die FDG-PET einen festen Platz in der Diagnostik erworben. Bei jeder dieser Tumorarten bietet sie eine hohe Treffsicherheit, die durch die Kombination mit der CT-Untersuchung noch gesteigert wird. Darüber hinaus ermöglicht die intrinsisch hochwertige Koregistrierung von PET und CT beim PET/CT die zuverlässige Zuordnung eines PET-Befundes zur Morphologie im - oft unauffälligen - CT-Bild. Neben der FDG-PET haben sich in der Diagnostik des Schilddrüsenkarzinom hochspezifische Tracer (131I, 123I, 111In-Pentetreotid) etabliert, die - allerdings nicht routinemäßig - auch als Positronenemitter verfügbar sind: 124I für das FTC und 68Ga-DOTATOC mit der Hauptanwendung beim MTC und dem onkozytären Schilddrüsenkarzinom. Für derartige hochspezifische Tracer ist die Koregistrierung mit dem CT von besonderer Wichtigkeit, da die PET-Bilder erheblich weniger anatomische Orientierungspunkte bieten als das FDG-Bild. Darüber hinaus ist die präzise Koregistrierung auch für die Volumetrie der Läsionen, die für die Dosimetrie vor Radioiod- oder Somatotstatin-vermittelter Radionuklid-Therapie essenziell ist, wertvoll.

Abstract

FDG-PET is well established in the diagnostics of the three histologic main groups of thyroid cancer: anaplastic, medullary (MTC) and follicular cell derived (FTC) cancer. For each of the histologic groups a high accuracy is established for FDG-PET which can be increased by combining with a CT investigation. Moreover the intrinsically precise coregistration of PET and CT when using PET/CT enables the reliable coregistration of PET findings to morphology in the - often normal - CT image. Besides FDG-PET highly specific tracers (131I, 123I, 111In-Pentetreotide) are established in the diagnostics of thyroid cancer. Such tracers are also available with positron emitters, however not yet on a routine basis: 124I for FTC and 68Ga-DOTATOC mainly for MTC and oncocytic thyroid cancer. For such highly specific tracers coregistration and especially the hardware based coregistration is of special importance, as the images display considerably less anatomic information compared to e. g. the FDG image. Moreover, the precise coregistration is valuable when performing volumetry of lesions, what is essential for dosimetry of radioiodine or somatostatin-related radionuclide therapy.

Schlüsselwörter

Schilddrüsenkarzinom - PET - PET/CT - FDG - 124I - 68Ga-DOTATOC

Key words

Thyroid cancer - PET - PET/CT - FDG - 124I - 68Ga-DOTATOC

Literatur

  • 1 Amodeo C, Caglia P, Gandolfo L, Veroux M, Donati M, Imme A. Undifferentiated carcinoma of the thyroid.  Tumori. 2003;  89 (Suppl) 205-206
    PubMedGoogle Scholar
  • 2 Antoch G, Vogt F M, Bockisch A, Ruehm S G. Whole-body tumor staging: MRI or FDG-PET/CT?.  Radiologe. 2004;  44 882-888
    PubMedGoogle Scholar
  • 3 Beyer T, Townsend D W, Brun T. et al . A combined PET/CT scanner for clinical oncology.  J Nucl Med. 2000;  41 1369-1379
    PubMedGoogle Scholar
  • 4 Bockisch A, Brandt-Mainz K, Gorges R, Muller S, Stattaus J, Antoch G. Diagnosis in medullary thyroid cancer with [18F]FDG-PET and improvement using a combined PET/CT scanner.  Acta Med Austriaca. 2003;  30 22-25
    CrossrefPubMedGoogle Scholar
  • 5 Bockisch A, Beyer T, Antoch G, Freudenberg L S, Kuehl H, Debatin J F, Müller S P. PET/CT-imaging protocols, artifacts, and pitfalls.  Mol Imaging Biol. 2004;  [in press]
    PubMedGoogle Scholar
  • 6 Bodei L, Handkiewicz-Junak D, Grana C, Mazzetta C, Rocca P, Bartolomei M, Lopera Sierra M, Cremonesi M, Chinol M, Macke H R, Paganelli G. Receptor radionuclide therapy with 90Y-DOTATOC in patients with medullary thyroid carcinomas.  Cancer Biother Radiopharm. 2004;  19 65-71
    CrossrefPubMedGoogle Scholar
  • 7 Brandt-Mainz K, Müller S P, Görges R, Saller B, Bockisch A. The value of fluorine-18 fluorodeoxyglucose PET in patients with medullary thyroid cancer.  Eur J Nucl Med. 2000;  27 490-496
    CrossrefPubMedGoogle Scholar
  • 8 Chin B B, Patel P. et al . Recombinant Human Thyrotropin Stimulation of Fluoro-D-Glucose Positron Emission Tomography Uptake in Well-Differentiated Thyroid Carcinoma.  J Clin Endocrinol Metab. 2004;  89 91-95
    CrossrefPubMedGoogle Scholar
  • 9 Clarke J C. PET/CT “Cometh the hour, cometh the machine?”.  Clin Radiol. 2004;  59 775-776
    CrossrefPubMedGoogle Scholar
  • 10 Crippa F, Alessi A. et al . FDG-PET in thyroid cancer.  Tumori. 2003;  89 540-543
    PubMedGoogle Scholar
  • 11 Diehl M, Risse J H. et al . Fluorine-18 fluorodeoxyglucose positron emission tomography in medullary thyroid cancer: results of a multicentre study.  Eur J Nucl Med. 2001;  28 1671-1676
    CrossrefPubMedGoogle Scholar
  • 12 Dietlein M, Dressler J. et al . Procedure guidelines for radioiodine therapy of differentiated thyroid cancer (version 2).  Nuklearmedizin. 2004;  43 115-120
    PubMedGoogle Scholar
  • 13 Dietlein M, Scheidhauer K. et al . Flourine-18 flouro deoxyglukose positron tomography and iodine-131 whole- body scintigraphy in the follow-up of differentiated thyroid cancer.  Eur J Nucl Med. 1997;  24 1342
    CrossrefPubMedGoogle Scholar
  • 14 Engelbach M, Görges R, Forst T, Pfützner A, Dawood R, Heerdt S, Kunt T, Bockisch A, Beyer J. Improved diagnostic methods in the follow-up of medularry thyroid carcinoma by highly specific calcitonin measurements.  J Clin Endocrinol Metab. 2000;  85 1890-1894
    CrossrefPubMedGoogle Scholar
  • 15 Erdi Y E, Macapinlac H, Larson S M, Erdi A K, Yeung H, Furhang E E, Humm J L. Radiation Dose Assessment for I-131 Therapy of Thyroid Cancer Using I-124 PET Imaging.  Clin Positron Imaging. 1999;  2 41-46
    CrossrefPubMedGoogle Scholar
  • 16 Eschmann S M, Reischl G. et al . Evaluation of dosimetry of radioiodine therapy in benign and malignant thyroid disorders by means of iodine-124 and PET.  Eur J Nucl Med Mol Imaging. 2002;  29 760-767
    CrossrefPubMedGoogle Scholar
  • 17 Feine U, Lietzenmayer R, Hanke J P, Wohrle H, Muller-Schauenburg W. 18FDG whole-body PET in differentiated thyroid carcinoma. Flipflop in uptake patterns of 18FDG and 131I.  Nuklearmedizin. 1995;  34 127-134
    PubMedGoogle Scholar
  • 18 Frasoldati A, Pesenti M, Gallo M, Caroggio A, Salvo D, Valcavi R. Diagnosis of neck recurrences in patients with differentiated thyroid carcinoma.  Cancer. 2003;  97 90-96
    CrossrefPubMedGoogle Scholar
  • 19 Freudenberg L S, Antoch G, Jentzen W, Pink R, Knust J, Gorges R, Muller S P, Bockisch A, Debatin J F, Brandau W. Value of (124)I-PET/CT in staging of patients with differentiated thyroid cancer.  Eur Radiol. 2004;  30 2092-2098
    PubMedGoogle Scholar
  • 20 Freudenberg L S, Antoch G. et al . Combined PET/CT with iodine-124 in diagnosis of spread metastatic thyroid carcinoma: a case report.  Eur Radiol. 2003;  13 (Suppl 4) 19-23
    PubMedGoogle Scholar
  • 21 Freudenberg L S, Antoch G. et al . 124I-PET/CT in metastatic follicular thyroid carcinoma.  Eur J Nucl Med. 2002;  29 1106
    CrossrefPubMedGoogle Scholar
  • 22 Freudenberg L S, Antoch G. et al . Combined PET/CT with Iodine-124 in diagnosis of mediastinal micrometastases in thyroid carcinoma.  Internet J Radiol. 2002;  2 2
    PubMedGoogle Scholar
  • 23 Frilling A, Tecklenborg K, Görges R, Weber F, Clausen M, Broelsch E C. Preoperative diagnostic value of [18F]Fluorodeoxyglucose Positron Emission Tomography in patients with radiodine-negative recurrent well-differentiated thyroid carcinoma.  Ann Surg. 2001;  234 804-811
    CrossrefPubMedGoogle Scholar
  • 24 Furhang E E, Larson S M. et al . Thyroid Cancer Dosimetry Using Clearance Fitting.  J Nucl Med. 1999;  40 131-136
    PubMedGoogle Scholar
  • 25 Görges R, Antoch G. et al . Combination PET/CT with 124I positron rays in metastatic follicular thyroid carcinoma.  Nuklearmedizin. 2002;  41 N 68-N 71
    PubMedGoogle Scholar
  • 26 Görges R, Brandt-Mainz K, Freudenberg L, Frilling A, Grimm W, Bockisch A. Kontinuierliche Sensitivitatssteigerung in der Schilddrüsenkarzinom-Nachsorge im Verlauf dreier Thyreoglobulin-IMA-Generationen.  Nuklearmedizin. 2003;  42 157-166
    PubMedGoogle Scholar
  • 27 Görges R, Liedke M O, Worm K, Frilling A, Bockisch A, Schmid K W. Rapid diagnosis of recurrence of a tall cell variant of papillary thyroid cancer by endogenous TSH stimulation.  Nuklearmedizin. 2003;  42 N15-N18
    PubMedGoogle Scholar
  • 28 Görges R, Eising E G, Fotescu D, Renzing-Kohler K, Frilling A, Schmid K W, Bockisch A, Dirsch O. Diagnostic value of high-resolution B-mode and power-mode sonography in the follow-up of thyroid cancer.  Eur J Ultrasound. 2003;  16 191-206
    CrossrefPubMedGoogle Scholar
  • 29 Görges R, Kahaly G, Muller-Brand J, Macke H, Roser H W, Bockisch A. Radionuclide-labeled somatostatin analogues for diagnostic and therapeutic purposes in nonmedullary thyroid cancer.  Thyroid. 2001;  11 647-659
    CrossrefPubMedGoogle Scholar
  • 30 Görges R. The changing epidemiology of thyroid cancer. In: Biersack HJ, Grünwald F (eds). Thyroid Cancer. Springer Verlag, Berlin, New York, Heidelberg 2001; 3-25
    Google Scholar
  • 31 Grauer A, Raue F, Ziegler R. Clinical usefulness of a new chemiluminescent two-site immunoassay for human calcitonin.  Exp Clin Endocrinol Diabetes. 1998;  106 353-359
    PubMedGoogle Scholar
  • 32 Grünwald F, Kälicke T. et al . Fluorine-18 fluorodeoxyglucose positron emission tomography in thyroid cancer: results of a multicentre study.  Eur J Nucl Med. 1999;  26 1547-1552
    CrossrefPubMedGoogle Scholar
  • 33 Hofmann M, Maecke H. et al . Biokinetics and imaging with the somatostatin receptor PET radioligand 68Ga-DOTATOC: preliminary data.  Eur J Nucl Med. 2001;  28 1751-1757
    CrossrefPubMedGoogle Scholar
  • 34 Jadvar H, Fischman A J. Evaluation of Rare Tumors with [F-18]Fluorodeoxy glucose Positron Emission Tomography.  Clin Positron Imaging. 1999;  2 153-158
    PubMedGoogle Scholar
  • 35 Kostakoglu L, Hardoff R. et al . PET-CT Fusion Imaging in Differentiating Physiologic from Pathologic FDG Uptake.  Radiographics. 2004;  24 1411-1431
    PubMedGoogle Scholar
  • 36 Loffler M, Weckesser M. et al . Iodine excretion during stimulation with rh-TSH in differentiated thyroid carcinoma.  Nuklearmedizin. 2003;  42 240-243
    PubMedGoogle Scholar
  • 37 Mazzaferi E L. Radioiodine and other treatments and outcomes. In: Braverman LE, Utiger RD (eds). Werner and Ingbar's The thyroid: a fundamental and clinical text. 7th ed. J. B. Lippincott-Raven, Philadelphia 1996; 922-943
    Google Scholar
  • 38 Moog F, Linke R. et al . Influence of thyroid-stimulating hormone levels on uptake of FDG in recurrent and metastatic differentiated thyroid carcinoma.  J Nucl Med. 2000;  41 1989-1995
    PubMedGoogle Scholar
  • 39 Petrich T, Borner A R, Otto D, Hofmann M, Knapp W H. Influence of rhTSH on [(18)F]fluorodeoxyglucose uptake by differentiated thyroid carcinoma.  Eur J Nucl Med Mol Imaging.. 2002;  29 641-647
    CrossrefPubMedGoogle Scholar
  • 40 Reske S N, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000.  Eur J Nucl Med. 2001;  28 1707-1723
    Google Scholar
  • 41 Townsend D W, Cherry S R. Combined anatomy and function: the path of true image fusion.  Eur Radiol. 2001;  11 1968-1974
    CrossrefPubMedGoogle Scholar
  • 42 Truong M T, Erasmus J J, Munden R F, Marom E M, Sabloff B S, Gladish G W, Podoloff D A, Macapinlac H A. Focal FDG Uptake in Mediastinal Brown Fat Mimicking Malignancy: A Potential Pitfall Resolved on PET/CT.  AJR Am J Roentgenol. 2004;  183 1127-1132
    CrossrefPubMedGoogle Scholar
  • 43 Valentin J. Radiation dose to patients from radiopharmaceuticals (Addendum 2 t oICRP Publication 53).  Ann ICRP. 1998;  28 3
    PubMedGoogle Scholar
  • 44 Wieler H, Bartenstein P. et al . Guideline for therapy of malignant thyroid tumours: pleading for an actualization.  Nuklearmedizin. 2004;  43 121-123
    PubMedGoogle Scholar
  • 45 Wiseman S M, Loree T R, Rigual N R, Hicks W L, Douglas W G, Anderson G R, Stoler D L. Anaplastic transformation of thyroid cancer: review of clinical, pathologic, and molecular evidence provides new insights into disease biology and future therapy.  Head Neck. 2003;  25 662-670
    CrossrefPubMedGoogle Scholar

Dr. S. Rosenbaum

Klinik für Nuklearmedizin · Universitätsklinikum Essen

Hufelandstraße 55

D-45122 Essen

Phone: 02 01/7 23 20 32

Fax: 02 01/7 23 59 64

Email: S.Rosenbaum@uni-essen.de