Tc-99m-Tetrofosmin Scintigraphy: An Alternative Scintigraphic Method for Following up Differentiated Thyroid Carcinoma

Summary

Aim: The usefulness of the myocardial perfusion agent, Tc-99m-tetrofosmin (Myoview^®) in the follow-up of differentiated thyroid carcinoma was evaluated in a clinical study of 15 patients, primary treated with thyroidectomy and high-dose I-131-therapy (2960-3700 MBq), 12 with suspected recurrence and metastases and three patients without any suspicion and compared with other non-specific tracers like TI-201 and Tc-99m-sestamibi. Method: Twelve patients with elevated thyroglobulin (Tg) levels of more than 10 ng/ml (group A), four of these had negative I-131 scans, and three patients with Tg levels less than 10 ng/ml (group B) were examined under TSH suppressive L-Thyroxine treatment. Whole body scans were taken with TI-201 (74 MBq; 20 min post injection), Tc-99m-sestamibi (370 MBq; 20-60 min post injection) and Tc-99m-tetrofosmin (370 MBq; 20-60 min post injection). Tumor/background ratios and optional time/activity analyses (up to 150 min post injection) were evaluated using the region of interest approach. Results: Compared with TI-201 (T/BG: 1.59, ± 0.396), Tc-99m-tetrofosmin showed slightly but not significant better T/BG ratios and detection rates (T/BG: 1.76, ± 0.345).Tc-99m-sestamibi (1.51, ± 0.31 p = 0.05) showea significantly lower values than Tc-99m-tetrofosmin. Conclusion: In the light of these results, scintigraphy with Tc-99m-tetrofosmin seems to be a possibly sensitive imaging modality in the follow-up of DTC with possible advantages concerning T/Bg ratio, background clearance, detection rate and dosimetry compared with TI-201 and Tc-99m-sestamibi, especially in patients with elevated Tg level and no iodine uptake , but further investigations are needed to confirm our preliminary results.

Zusammenfassung

Ziel: Die Verwendbarkeit des myokardialen Perfusionstracers Tc-99m-Tetrofosmin (Myoview^®) für die Nachsorge des differenzierten Schilddrüsenkarzinoms wurde in einer Pilotstudie an primär operierten und ra-diojodtherapierten Patienten (12 Patienten mit Tg >10 ng/ml, 3 Patienten <10 ng/ml) evaluiert und der TI-201 und Tc-99m-Sestamibiszintigra-phie gegenübergestellt. Methoden: Nach Durchführung von Ganzkör-perszintigrammen mit Tc-99m-Tetrofosmin (370 MBq), Tc-99m-Sestamibi (370 MBq) und TI-201 (74 MBq) wurden mit Hilfe der ROI Methode T/Bg Ratios errechnet und optionale Zeit/Aktivitätsanalysen durchgeführt. Ergebnisse: Tc-99m-Tetrofosmin zeigt nach unseren vorläufigen Ergebnissen geringe Vorteile hinsichtlich Detektionsrate sowie T/Bg Ratio (T/BG: 1.76, ± 0.345) gegenüber TI-201 (T/BG: 1.59, ± 0.396) und Tc-99m-Sestamibi (1.51, ± 0.31 p = 0.05). Schlußfolgerung: Die Ganz-körperszintigraphie mit Tc-99m-Tetrofosmin stellt somit eine potentielle Alternative mit möglichen Vorteilen gegenüber anderen unspezifischen Tracern in der Nachsorge des differenzierten Schilddrüsenkarzinoms dar, speziell bei Patienten mit erhöhtem Tg-Spiegel und fehlender J-131 -Speicherung.

Keywords

Differentiated thyroid carcinoma - TI-201 - Tc-99m-sestamibi - Tc-99m-tetrofosmin

Schlüsselwörter

Differenziertes Schilddrüsenkarzinom - TI-201 - Tc-99m-Tetrofosmin - Tc-99m-Sestamibi

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