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Nuklearmedizin 2013; 52(03): 81-87
DOI: 10.3413/Nukmed-0525-12-08
Original article
Schattauer GmbH

Improved follow-up of patients with differentiated thyroid carcinoma

The quantitative detection limit of 131I uptake in diagnostic scansBessere Nachsorge bei Patienten mit differenziertem SchilddrüsenkarzinomDie quantitative 131I-Uptake-Nachweisgrenze diagnostischer Scans
S. Dießl
1   Department of Nuclear Medicine, University of Würzburg, Germany
,
F. Verburg
1   Department of Nuclear Medicine, University of Würzburg, Germany
2   Department of Nuclear Medicine, RWTH Aachen, University Hospital Aachen, Germany
,
J. Biko
1   Department of Nuclear Medicine, University of Würzburg, Germany
,
B. Schryen
1   Department of Nuclear Medicine, University of Würzburg, Germany
,
C. Reiners
1   Department of Nuclear Medicine, University of Würzburg, Germany
,
A. Buck
1   Department of Nuclear Medicine, University of Würzburg, Germany
,
H. Hänscheid
1   Department of Nuclear Medicine, University of Würzburg, Germany
› Author Affiliations
Further Information

Publication History

received: 03 August 2012

accepted in revised form: 04 February 2013

Publication Date:
30 December 2017 (online)

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Summary

Aim: Physicians typically are unaware of the radioiodine uptake (RIU) detection limit (LoD) on scintigrams of differentiated thyroid carcinoma (DTC) patients. We evaluated a novel method to determine LoD as a quantitative upper limit for RIU in negative scans and as a value to contextualize faint visible uptake. Patients, methods: To test whether LoD is related to physicians’ ratings, RIU and LoD were calculated from scintigraphic count statistics for 120 static planar neck scans and were compared with the ratings of five nuclear medicine specialists blinded to patient/ scan characteristics regarding visible cervical uptake. Scans were acquired on days 1 (d1) and 2 (d2) post-administration of 298 ± 30 MBq iodine-131 in 60 consecutive DTC patients after recombinant human thyrotropin (rhTSH) or thyroid hormone withdrawal (THW) (n = 30 each). Results: Indicating good inter-observer agreement, ≥ 4 readers concurred regarding 56 (93.3%) [54 (90.0%)] d1[d2] scans. Seventeen scans from 12 patients received ≥ 3 positive votes; in 15 (88.2%), RIU exceeded LoD. RIU assessed from regions-of-interest over former thyroid beds in scans with ≤ 2 positive votes was typically below the LoD (99/103 scans, 96.1%). In 48 patients with ≤ 2 positive votes in both scans, LoD was a median 0.0094% (0.0050%) in d1(d2) images and was significantly lower (p < 0.01) on early or late scans in 22 euthyroid rhTSH patients versus 26 hypo thyroid THW patients. Conclusion: LoD data obtained by the proposed method closely reflect nuclear medicine specialists’ scan ratings and provide comparators in serial scintigrams, improving diagnostic 131I imaging accuracy in differentiated thyroid carcinoma.

Zusammenfassung

Ziel: Die Nachweisgrenze (LoD) für 131I-Anreicherungen (RIU) in Szintigrammen von Patienten mit differenziertem Schilddrüsenkarzinom (DTC) ist dem behandelnden Nuklearmediziner in der Regel nicht bekannt. Wir untersuchten ein objektives Verfahren zur Bestimmung des LoD als quantitative Obergrenze für den RIU in negativen Szintigrammen und zur Einordnung der diagnostischen Wertig keit schwach sichtbarer Iod-Anreicherungen. Patienten , Methode: Um zu prüfen, ob das LoD die ärztliche Diagnose bezüglich des Vorhandenseins einer Restspeicherung widerspiegelt, wurden für 120 statische planare Hals szintigramme RIU und LoD aus der szintigraphischen Zählstatistik berechnet und mit den Befunden fünf erfahrener Nuklearmediziner, die die Patientenzuordnungen und die Aufnahmeeigenschaften nicht kannten, verglichen. Die Aufnahmen stammten von 60 konsekutiven Patienten mit DTC, die nach rekombinantem humanen Thyreotropin (rhTSH) oder Schilddrüsenhormonentzug (THW) (je n = 30) am Tag 1 (d1) und Tag 2 (d2) nach Verabreichung von 298 ± 30 MBq 131I szintigraphisch untersucht wurden. Ergebnisse: Die Übereinstimmung der Befunder war gut, ≥ 4 Ärzte bewerteten 56 (93,3%) der d1-bzw. 54 (90%) der d2-Aufnahmen identisch. Von 17 Szintigrammen von 12 verschiedenen Patienten, die von ≥ 3 als positiv gewertet wurden, war bei 15 (88,2%) der RIU > LoD. Die Berechnung des RIU aus der Zählstatistik über dem ehemaligen Schilddrüsenbett in Aufnahmen mit ≤ 2 positiven Befunden lag fast immer unterhalb der Nachweisgrenze (99/103, 96,1%). Bei 48 Patienten wurden d1- und d2-Aufnahmen mehrheitlich negativ befundet. Bei diesen lag der Median der LoD bei 0,0094% nach Tag 1 bzw. 0,0050% nach Tag 2 und an beiden Tagen war das LoD signifikant niedriger (p < 0,01) bei 22 euthyreoten im Vergleich zu 26 hypothyreoten Patienten. Schlussfolgerung: Die LoD-Werte spiegeln eng die Befundung nuklearmedizinischer Spezialisten wider und erlauben den objektiven Vergleich konsekutiver Szintigramme, wodurch die Wertigkeit der Diagnostik mit 131I bei Patienten mit differenziertem Schilddrüsenkarzinom verbessert wird.

Keywords

Thyroid carcinoma - 131I uptake - radioiodine - diagnostic scan - scintigraphy - quantitative detection limits

Schlüsselwörter

Schilddrüsenkarzinom - 131I-Uptake - Radioiod - diagnostischer Scan - Szintigraphie - quantitative Nachweisgrenzen
 

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