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DOI: 10.1055/s-0030-1270481
© Georg Thieme Verlag KG Stuttgart · New York
SPECT/CT bei differenziertem Schilddrüsenkarzinom
SPECT/CT in Differentiated Thyroid CarcinomaPublication History
Publication Date:
23 March 2011 (online)
![](https://www.thieme-connect.de/media/nuklmed/201101/lookinside/thumbnails/10.1055-s-0030-1270481-1.jpg)
Zusammenfassung
Die szintigrafische Bildgebung der Verteilung von Iodisotopen wird zum Staging von Patienten mit differenziertem Schilddrüsenkarzinom verwendet. Planare Szintigrafien mit einer Gammakamera sowie SPECT visualisieren iodakkumulierende Herde mit hoher Sensitivität. Allerdings ist die diagnostische Genauigkeit dieser Technik aufgrund des weitgehenden Fehlens morphologischer Informationen begrenzt. Diese Limitation lässt sich durch den Einsatz von Hybridsystemen bei denen eine SPECT Kamera und ein CT Scanner integriert sind umgehen. Aktuelle Studien haben gezeigt, dass ungefähr ein Drittel der Patienten mit einem diagnostisch unklaren Radioiod anreichernden Fokus vom Einsatz der SPECT/CT profitieren, auch im Bezug auf das therapeutische Management. Daher entwickelt sich die SPECT/CT zu einem neuen klinischen Verfahren bei differenziertem Schilddrüsenkarzinom.
Abstract
Scintigraphic imaging of the distribution of isotopes of radioiodine is frequently performed for staging patients with differentiated thyroid carcinoma. Planar gamma-camera imaging, as well as SPECT, visualize foci of radioiodine accumulation with high sensitivity. However, owing to only poor visualization of the morphology by these techniques, their diagnostic accuracy is limited. This limitation is overcome when hybrid systems integrating a SPECT camera with a x-ray CT scanner are used. Recent evidence has demonstrated that approximately a third of patients with diagnostically unclear foci of radioiodine accumulation will benefit from the use of SPECT/CT, also in terms of therapeutic management. Therefore, SPECT/CT is rapidly evolving as a new clinical tool in differentiated thyroid carcinoma.
Schlüsselwörter
SPECT/CT - Hybridbildgebung - Schilddrüsenkarzinom - Radioiod
Key words
SPECT/CT - hybrid imaging - thyroid carcinoma - radioiodine
Literatur
- 1 Agriantonis DJ, Hall L, Wilson MA. Utility of SPECT/CT as an adjunct to planar whole body I-131 imaging: liver metastasis from papillary thyroid cancer. Clin Nucl Med. 2009; 34 247-248
- 2 Aide N, Lehembre E, Gervais R. et al . Unusual intratracheal metastasis of differentiated thyroid cancer accurately depicted by SPECT/CT acquisition after radioiodine ablation. Thyroid. 2007; 17 1305-1306
- 3 Aide N, Heutte N, Rame JP. et al . Clinical relevance of single-photon emission computed tomography/computed tomography of the neck and thorax in postablation (131)I scintigraphy for thyroid cancer. J Clin Endocrinol Metab. 2009; 94 2075-2084
- 4 Bockisch A, Freudenberg LS, Schmidt D. et al . Hybrid imaging by SPECT/CT and PET/CT – proven outcomes in cancer imaging. Semin Nucl Med. 2009; 39 276-289
- 5 Chen L, Luo Q, Shen Y. et al . Incremental value of 131I SPECT/CT in the management of patients with differentiated thyroid carcinoma. J Nucl Med. 2008; 49 1952-1957
- 6 Cooper DS, Doherty GM, Haugen BR. et al . Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009; 19 1167-1214
- 7 Greene FL, Page DL, Fleming ID. et al .. (eds.) AJCC Cancer Staging Handbook. Springer, New York; 2002
- 8 Hay ID, McDougall IR, Sisson JC. A Proposition for the Use of Radioiodine in WDTC Management. J Nucl Med. 2008; 49 1395-1397
- 9 Kohlfuerst S, Igerc I, Lobnig M. et al . Posttherapeutic 131I SPECT-CT offers high diagnostic accuracy when the findings on conventional planar imaging are inconclusive and allows a tailored patient treatment regimen. Eur J Nucl Med Mol Imaging. 2009; 36 886-893
- 10 Lind P, Kohlfürst S. Respective roles of thyroglobulin, radioiodine imaging, and positron emission tomography in the assessment of thyroid cancer. Semin Nucl Med. 2006; 36 194-205
- 11 Macdonald W, Armstrong J. Benign struma ovarii in a patient with invasive papillary thyroid cancer: detection with I-131 SPECT-CT. Clin Nucl Med. 2007; 32 380-382
- 12 Mariani G, Bruselli L, Kuwert T. et al . A review on the clinical uses of SPECT/CT. Eur J Nucl Med Mol Imaging. 2010; 37 1959-1985
- 13 Mustafa M, Kuwert T, Weber K. et al . Regional lymph node involvement in T1 papillary thyroid carcinoma: a bicentric prospective SPECT/CT study. Eur J Nucl Med Mol Imaging. 2010; 37 1462-1466
- 14 Pacini F, Schlumberger M, Dralle H. et al The European Thyroid Cancer Taskforce European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006; 154 787-803
- 15 Patton JA, Townsend DW, Hutton BF. Hybrid imaging technology: from dreams and vision to clinical devices. Semin Nucl Med. 2009; 39 247-263
- 16 Qiu ZL, Luo QY. Erector spinae metastases from differentiated thyroid cancer identified by I-131 SPECT/CT. Clin Nucl Med. 2009; 34 137-140
- 17 Rachinsky I, Driedger A. Iodine-131 uptake in a menstruating uterus: value of SPECT/CT in distinguishing benign and metastatic iodine-positive lesions. Thyroid. 2007; 17 901-902
- 18 Ruf J, Lehmkuhl L, Bertram H. et al . Impact of SPECT and integrated low-dose CT after radioiodine therapy on the management of patients with thyroid carcinoma. Nucl Med Commun. 2004; 25 1177-1182
- 19 Schlumberger M, Pacini F. Thyroid Tumors. Paris: Editions Nucléon; 2003
- 20 Schmidt D, Szikszai A, Linke R. et al . Impact of 131I SPECT/Spiral CT on nodal staging of differentiated thyroid carcinoma at the first radioablation. J Nucl Med. 2009; 50 18-23
- 21 Schmidt D, Linke R, Uder M. et al . Five months’ follow-up of patients with and without iodine-positive lymph node metastases of thyroid carcinoma as disclosed by (131)I-SPECT/CT at the first radioablation. Eur J Nucl Med Mol Imaging. 2010; 37 699-705
- 22 Shapiro B, Rufini V, Jarwan A. et al . Artifacts, anatomical and physiological variants, and unrelated diseases that might cause false-positive whole-body I-131 scans in patients with thyroid cancer. Semin Nucl Med. 2000; 30 115-132
- 23 Sisson JC, Dewaraja YK, Wizauer EJ. et al . Thyroid carcinoma metastasis to skull with infringement of brain: treatment with radioiodine. Thyroid. 2009 Mar; 19 297-303
- 24 Song H, He B, Prideaux A. et al . Lung dosimetry for radioiodine treatment planning in the case of diffuse lung metastases. J Nucl Med. 2006; 47 1985-1994
- 25 Spanu A, Solinas ME, Chessa F. et al . 131I SPECT/CT in the Follow-up of Differentiated Thyroid Carcinoma: Incremental Value Versus Planar Imaging. J Nucl Med. 2009; 50 184-190
- 26 Tharp K, Israel O, Hausmann J. et al . Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2004; 31 1435-1442
- 27 Thust S, Fernando R, Barwick T. et al . SPECT/CT identification of post-radioactive iodine treatment false-positive uptake in a simple renal cyst. Thyroid. 2009; 19 75-76
- 28 Verburg FA, Dietlein M, Lassmann M. et al . Why radioiodine remnant ablation is right for most patients with differentiated thyroid carcinoma. Eur J Nucl Med Mol Imaging. 2009; 36 343-346
- 29 von Falck C, Beer G, Gratz KF. et al . Renal metastases from follicular thyroid cancer on SPECT/CT. Clin Nucl Med. 2007; 32 751-752
- 30 Wang H, Fu HL, Li JN. et al . The role of single-photon emission computed tomography/computed tomography for precise localization of metastases in patients with differentiated thyroid cancer. Clin Imaging. 2009; 33 49-54
- 31 Wong KK, Zarzhevsky N, Cahill JM. et al . Incremental value of diagnostic 131I SPECT/CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR Am J Roentgenol. 2008; 191 1785-1794
- 32 Wong KK, Avram AM. Posttherapy I-131 thymic uptake demonstrated with SPECT/CT in a young girl with papillary thyroid carcinoma. Thyroid. 2008; 18 919-920
- 33 Wong KK, Zarzhevsky N, Cahill JM. et al . Hybrid SPECT-CT and PET-CT imaging of differentiated thyroid carcinoma. Br J Radiol. 2009; 82 860-876
- 34 Yamamoto Y, Nishiyama Y, Monden T. et al . Clinical usefulness of fusion of I-131 SPECT and CT images in patients with differentiated thyroid carcinoma. J Nucl Med. 2003; 44 1905-1910
Korrespondenzadresse
Dr. Daniela Schmidt
Klinik für Nuklearmedizin
Universität Erlangen-Nürnberg
Krankenhausstraße 12
91054 Erlangen
Phone: +49/9131/853 3411
Fax: +49/9131/853 9262
Email: Daniela.Schmidt@uk-erlangen.de