sodium-pertechnetate-tc-99m and Adenocarcinoma

A case of follicular thyroid cancer appearing as an autonomous nodule on Tc-99m and I-123 thyroid scintigraphy is presented in addition to a pertinent review of the literature.

Topics: Adenocarcinoma; Adenoma; Aged; Diagnosis, Differential; Female; Humans; Iodine Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Thyroid cancer is uncommon, with an incidence of 10,300 new patients each year and a mortality of 1,100 patients each year. Patient survival correlates with many factors, including tumor pathology, age, primary lesion size, distant metastases, extent of surgery, and radioiodine therapy. Deaths from thyroid cancer may occur many years after diagnosis, and such an indolent course has hampered the analysis of the multiple treatment programs advocated. Thyroid imaging continues to play an important role in the initial detection and follow-up management of thyroid cancer, but the search for a specific tracer for the primary lesion continues. The complementary role of serum thyroglobulin and radioiodine in the follow-up of the thyroidectomized patient is discussed. Radioiodine therapy has proven effectiveness in those patients with radioiodine-avid distant metastases and/or regional metastases. Whether radioiodine ablation of residual thyroid bed activity is beneficial remains controversial.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Iodine Radioisotopes; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

To evaluate the prognostic value of postoperative Tc-99m pertechnetate scanning in patients with differentiated thyroid cancer (DTC).. Patients with pathologically proven low or intermediate-risk DTC were enrolled in this study. Postoperative Tc-99m pertechnetate scintigraphy was performed 20 min after IV of 185 MBq of Tc-99m pertechnetate Positive thyroid residual uptake was characterized as higher Tc-99m pertechnetate uptake at the thyroid bed than the surrounding background's activity. A negative residual was considered if there was no definite abnormal radioactivity at the thyroid bed. Follow-up by thyroglobulin, thyroglobulin antibodies (Tg Abs), neck ultrasound (US) and diagnostic I-131 WBS (Dx WBS) were considered the reference standard. Successful ablation outcome was considered if there was free Dx WBS, stimulated serum thyroglobulin < 1 ng/ml with negative Tg Abs, and free US.. Two hundred and two patients, mean age; of 38.8 years were retrospectively recruited in this study. Positive residual uptake at the thyroid scan was detected in 131 patients wherea the remaining 71 patients had no detectable uptake. According to the reference standard we encountered 114 and 88 cases with successful ablation and unsuccessful ablation respectively, Tc-99m pertechnetate scanning successfully detected 63 true positive and 46 true negative cases giving 72% sensitivity, 40% specificity, 48% positive predictive value and 56% negative predictive value.. In low- and intermediate-risk DTC patients; despite the relatively high sensitivity of postoperative Tc-99m pertechnetate thyroid scan, it has low specificity and low negative predictive value so it cannot be used to predict the ablation outcome.

Topics: Adenocarcinoma; Humans; Iodine Radioisotopes; Prognosis; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroglobulin; Thyroid Neoplasms; Thyroidectomy; Tomography, X-Ray Computed

Possible thyroiditis was suspected in a 56-year-old man who initially presented sore throat because laboratory examinations revealed decreased serum thyroid hormone and the Tc-pertechnetate scintigraphy showed no tracer uptake by the thyroid gland. However, subsequent examination demonstrated that the absence of pertechnetate activity in the thyroid was due to complete replacement of thyroid gland by the metastasis from lung adenocarcinoma, which was unknown at the initial presentation.

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Diagnosis, Differential; Humans; Lung Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroiditis

Imaging spontaneous cancer cell metastasis or heterogeneous tumor responses to drug treatment in vivo is difficult to achieve. The goal was to develop a new highly sensitive and reliable preclinical longitudinal in vivo imaging model for this purpose, thereby facilitating discovery and validation of anticancer therapies or molecular imaging agents.. The strategy is based on breast cancer cells stably expressing the human sodium iodide symporter (NIS) fused to a red fluorescent protein, thereby permitting radionuclide and fluorescence imaging. Using whole-body nano-SPECT/CT with (99m)TcO4(-), we followed primary tumor growth and spontaneous metastasis in the presence or absence of etoposide treatment. NIS imaging was used to classify organs as small as individual lymph nodes (LNs) to be positive or negative for metastasis, and results were confirmed by confocal fluorescence microscopy. Etoposide treatment efficacy was proven by ex vivo anticaspase 3 staining and fluorescence microscopy.. In this preclinical model, we found that the NIS imaging strategy outperformed state-of-the-art (18)F-FDG imaging in its ability to detect small tumors (18.5-fold-better tumor-to-blood ratio) and metastases (LN, 3.6-fold) because of improved contrast in organs close to metastatic sites (12- and 8.5-fold-lower standardized uptake value in the heart and kidney, respectively). We applied the model to assess the treatment response to the neoadjuvant etoposide and found a consistent and reliable improvement in spontaneous metastasis detection. Importantly, we also found that tumor cells in different microenvironments responded in a heterogeneous manner to etoposide treatment, which could be determined only by the NIS-based strategy and not by (18)F-FDG imaging.. We developed a new strategy for preclinical longitudinal in vivo cancer cell tracking with greater sensitivity and reliability than (18)F-FDG PET and applied it to track spontaneous and distant metastasis in the presence or absence of genotoxic stress therapy. Importantly, the model provides sufficient sensitivity and dynamic range to permit the reliable assessment of heterogeneous treatment responses in various microenvironments.

Topics: Adenocarcinoma; Antineoplastic Agents, Phytogenic; Breast Neoplasms; Cell Line, Tumor; DNA Damage; Environment; Etoposide; Female; Fluorescence; Humans; Lymph Nodes; Microscopy, Confocal; Neoadjuvant Therapy; Neoplasm Metastasis; Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals; Reproducibility of Results; Sodium Pertechnetate Tc 99m; Symporters; Tissue Distribution; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Whole Body Imaging

Topics: Adenocarcinoma; Adult; Bone Neoplasms; Digestive System Neoplasms; Humans; Iodine Radioisotopes; Lymph Nodes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

The sodium/iodide symporter (NIS) has been recognized as an attractive target for radioiodine-mediated cancer gene therapy. In this study we investigated the role of human NIS for cellular uptake of the high LET alpha-emitter astatine-211 ((211)At) in comparison with radioiodine as a potential radionuclide for future applications. A mammalian NIS expression vector was constructed and used to generate six stable NIS-expressing cancer cell lines (three derived from thyroid carcinoma, two from colon carcinoma, one from glioblastoma). Compared with the respective control cell lines, steady state radionuclide uptake of NIS-expressing cell lines increased up to 350-fold for iodine-123 ((123)I), 340-fold for technetium-99m pertechnetate ((99m)TcO(4)(-)) and 60-fold for (211)At. Cellular (211)At accumulation was found to be dependent on extracellular Na(+) ions and displayed a similar sensitivity towards sodium perchlorate inhibition as radioiodide and (99m)TcO(4)(-) uptake. Heterologous competition with unlabelled NaI decreased NIS-mediated (211)At uptake to levels of NIS-negative control cells. Following uptake both radioiodide and (211)At were rapidly (apparent t(1/2) 3-15 min) released by the cells as determined by wash-out experiments. Data of scintigraphic tumour imaging in a xenograft nude mice model of transplanted NIS-modified thyroid cells indicated that radionuclide uptake in NIS-expressing tumours was up to 70 times ((123)I), 25 times ((99m)TcO(4)(-)) and 10 times ((211)At) higher than in control tumours or normal tissues except stomach (3-5 times) and thyroid gland (5-10 times). Thirty-four percent and 14% of the administered activity of (123)I and (211)At, respectively, was found in NIS tumours by region of interest analysis ( n=2). Compared with cell culture experiments, the effective half-life in vivo was greatly prolonged (6.5 h for (123)I, 5.2 h for (211)At) and preliminary dosimetric calculations indicate high tumour absorbed doses (3.5 Gy/MBq(tumour) for (131)I and 50.3 Gy/MBq(tumour) for (211)At). In conclusion, NIS-expressing tumour cell lines of different origin displayed specific radionuclide uptake in vitro and in vivo. We provide first direct evidence that the high-energy alpha-emitter (211)At is efficiently transported by NIS. Application of (211)At may direct higher radiation doses to experimental tumours than those calculated for (131)I. Thus, (211)At may represent a promising alternative radionuclide for future NIS-based tumour thera

Topics: Adenocarcinoma; Adenocarcinoma, Papillary; Animals; Astatine; Biomarkers, Tumor; Colonic Neoplasms; Gene Expression; Glioblastoma; Humans; Iodine Radioisotopes; Mice; Mice, Nude; Neoplasm Transplantation; Radionuclide Imaging; Radiopharmaceuticals; Reference Values; Reproducibility of Results; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Symporters; Thyroid Neoplasms; Tissue Distribution; Tumor Cells, Cultured

The use of antibodies as targeting agents for the delivery of radioisotopes to tumors is a promising concept that has received widespread attention since the advent of monoclonal antibody (mAb) technology. The following studies are described in this article: the 99mTc-randiolabeling of 2-iminothiolane (2-IT) modified antibodies and 6-p-isothiocyanatobenzyl- diethylene-triamine penta-acetic acid (CITC-DTPA) immunoconjugates of anti-EGF-receptor antibodies murine ior egf/r3 and humanized h-R3; the analytical methods for quality control of the radiopharmaceutical such as instant thin layer chromatography-silica gel (ITLC-SG); the biological assessment of the radiolabeled molecule using flow cytometry analysis; in vitro stability studies with cysteine and DTPA challenge and the biodistribution studies in 4NMRI xenografted nude mice with U-87 human glioblastoma multiforme and MDA-MB-468 breast cancer cell lines. Labeling efficency of (96.48 +/- 0.70%) (98.42 +/- 0.38%), (94.8 +/- 1.25%) and (96.41 +/- 0.89%) was achieved for 99mTC-2-IT ior efg/r3, 99mTc-CITC-DTPA- ior egf/r3, 99mTc-CITC-DTPA- h-R3 and 99mTc-DIACIM h-R3, respectively. Radiocolloids were less than 2.0% in all cases. The biological activity measured by flow cytometry analysis using the MDA-MB-468 breast cancer cell line showed an immunoreactivity fraction greater than 85% in all concentrations of each immunoconjugate. Challenge studies demonstrated no evidence of transcomplexation of 99mTc to 1.0 mM DTPA for 2-IT modified antibody ior egf/r3 and CITC-DTPA immunoconjugates and only 8.7%, 4.9% and 5.0% of the 99mTc-radiolabeled was transcomplexed to 1.0 mM cysteine after 1 h incubation at 37 degrees C for 2-IT modified antibody ior egf/r3, CITC-DTPA ior egf/r3 and CITC-DTPA h-R3, respectively. Biodistribution studies with 2-IT modified antibodies and CITC-DTPA immunoconjugates indicated high tumor uptake in both cell lines with both immunoconjugates and no accumulation of the radiolabeled antibodies in normal organs.

Topics: Adenocarcinoma; Animals; Antibodies, Monoclonal; Antigens, Neoplasm; Breast Neoplasms; Central Nervous System Neoplasms; Colonic Neoplasms; Cross-Linking Reagents; Disease Models, Animal; ErbB Receptors; Glioblastoma; Humans; Imidoesters; Immunoconjugates; Immunoglobulin G; Immunoradiometric Assay; Isothiocyanates; Mice; Mice, Inbred BALB C; Mice, Nude; Neoplasm Transplantation; Pentetic Acid; Sodium Pertechnetate Tc 99m; Tissue Distribution; Tumor Cells, Cultured

Solitary hyperfunctioning nodules of the thyroid gland are usually viewed as benign. They may present with autonomous euthyroidism but are of concern for potential progression to hyperthyroidism. Various methods of treatment are worthy of consideration.. Forty-five patients with solitary hot thyroid nodules verified by radioisotope scintiscanning were selected for treatment. Thirty-one underwent surgery, usually partial thyroidectomy. Eight euthyroid patients received no treatment, 5 underwent therapy with radioactive iodine (RAI), and 1 received thyroid suppression treatment. The cases were assessed retrospectively.. Thyroidectomy patients had no morbidity, were well, and showed 1 Hürthle cell tumor and 5 coincidental small malignancies associated with benign hot nodules, including a contralateral cancer. Untreated patients showed continuance of good health, but nodules persisted and 1 Graves' orbititis occurred. The RAI-treated patients had persistent nodularity, improved function, and 1 case of hyperparathyroidism. Thyroid feeding only caused iatrogenic toxicity and was discontinued.. There are various techniques for managing the hot nodule. Nonsurgical methods may be effective, but can result in persistent nodularity and iatrogenic sequelae. Excision had no morbidity in this series and was effective in providing immediate relief of problems present and potential.

Topics: Adenocarcinoma; Adenocarcinoma, Follicular; Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma; Disease Progression; Female; Follow-Up Studies; Graves Disease; Humans; Hyperparathyroidism; Hyperthyroidism; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroid Nodule; Thyroidectomy; Thyroxine; Triiodothyronine

An 82-year-old man had his third episode of melanotic stool. Two previous workups had failed to localize the source of bleeding. A Tc-99m labeled RBC scan visualized the gallbladder early in the study. Administration of sincalide visually decreased the activity, confirming gallbladder activity. Three months later, at his second surgery, hepatic metastases were finally identified as the source of bleeding. In retrospect, the hepatic activity is inhomogeneous with at least two cold defects that could have represented hepatic metastases.

Topics: Adenocarcinoma; Aged; Diverticulum; Erythrocytes; Gallbladder; Gastrointestinal Hemorrhage; Hemobilia; Humans; Jejunal Diseases; Liver Neoplasms; Male; Neoplasms, Unknown Primary; Radionuclide Imaging; Sincalide; Sodium Pertechnetate Tc 99m

The usefulness of combined Tc-99m and Ga-67 scans in diagnosing salivary gland disorders was evaluated in a total of 31 patients. Out of 6 patients with Warthin's tumor, 4 showed a typical pattern of high-activity in the gland with retention of Tc-99m, but without an affinity for Ga-67. Out of 9 patients with pleomorphic adenoma, 8 showed a "cold" area in the tumor by Tc-99m and 5 of the 9 patients had accumulated Ga-67. Five of 6 patients with malignant tumor showed an affinity for Ga-67. Nine of 10 patients with sialadenitis showed diffuse uptake of both Tc-99m and Ga-67 in the involved gland. Combined Tc-99m and Ga-67 imaging was useful in detecting the cases of Warthin's tumor and sialadenitis (90% sensitivity and 89% specificity for sialadenitis), but the study had limitations in differentiating malignant tumors from benign tumors (66% sensitivity and 84% specificity). However, Ga-67 imaging showed a 91% negative predictive value. A negative scan could almost rule out the possibility of malignant disease of the salivary gland.

Topics: Adenocarcinoma; Adenolymphoma; Adenoma, Pleomorphic; Adolescent; Adult; Aged; Aged, 80 and over; Child; Citrates; Citric Acid; Female; Humans; Male; Middle Aged; Mixed Tumor, Malignant; Parotid Neoplasms; Radionuclide Imaging; Salivary Gland Diseases; Sialadenitis; Sodium Pertechnetate Tc 99m; Submandibular Gland Neoplasms

Thyroid gland scintigraphy was performed in 29 dogs with histologically confirmed thyroid tumors. Twenty dogs were female, and 9 were male. Median age was 10 years. Of the 29 dogs, 21 were initially examined because of cervical swelling or a cervical mass. Of the 29 tumors, 24 were thyroid adenocarcinomas, 1 was a C-cell carcinoma, 3 were undifferentiated carcinomas, and 1 was a thyroid adenoma. Serum triiodothyronine and thyroxine concentrations were determined in 25 dogs. Sixteen dogs were euthyroid, 6 were hyperthyroid, and 3 were hypothyroid. In all 29 dogs, results of scintigraphy were abnormal. The most common scintigraphic appearance (13 dogs) was a unilateral thyroid mass with increased radionuclide uptake, relative to that of the parotid salivary glands. There did not appear to be an association between distribution of radionuclide uptake and histologic diagnosis, although there appeared to be an association between distribution of uptake and histologic degree of capsular invasion. All 4 dogs with extensive capsular invasion and 11 of 17 dogs with limited capsular invasion had poorly circumscribed, heterogeneous uptake of pertechnetate by the tumor. All hyperthyroid dogs had intense uptake, and 5 of 6 hyperthyroid dogs had well-circumscribed, homogenous uptake. Scintigraphy did not appear to offer any additional benefit, compared with thoracic radiography, for detection of pulmonary metastases.

Topics: Adenocarcinoma; Adenoma; Animals; Carcinoma; Carcinoma, Medullary; Dog Diseases; Dogs; Female; Lung Neoplasms; Male; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroxine; Triiodothyronine

Topics: Adenocarcinoma; Child; Female; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroid Nodule

One hundred patients, each with a solitary thyroid nodule detected by clinical palpation, underwent three-phase Tc-99m pertechnetate thyroid imaging. The degree of perfusion of the thyroid nodule was classified as hypo-perfused, euperfused, or hyperperfused compared to the remainder of the gland by a consensus of three nuclear medicine physicians. The nodules were subsequently biopsied, and the degree of perfusion of the nodules was correlated with their histologic diagnosis. Twenty-two nodules were classified as hyperperfused, 64 as euperfused, and 14 as hypoperfused. Malignancy rates of the hyperperfused, euperfused, and hypoperfused nodules were 36%, 31% and 0%, respectively. This seems to indicate that malignant thyroid nodules demonstrate a degree of perfusion at least equal to or greater than the rest of the thyroid gland. Conversely, none of the hypoperfused nodules was found to be malignant. The perfusion phase of thyroid imaging may provide useful clinical information regarding possible malignancy of a thyroid nodule.

Topics: Adenocarcinoma; Adenoma; Adolescent; Adult; Aged; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Nodule

Topics: Adenocarcinoma; Aged; Carboplatin; Combined Modality Therapy; Graphite; Humans; Lung; Lung Neoplasms; Male; Pulmonary Fibrosis; Radionuclide Imaging; Radiotherapy; Sodium Pertechnetate Tc 99m

A 33-year-old man presented with colicky, intermittent, midabdominal pain with nausea and vomiting. A Tc-99m pertechnetate abdominal scan was performed and revealed a focal area of increased uptake in the midabdomen associated with dilated proximal loops of small bowel. Surgery revealed a high-grade partial obstruction of the midportion of the jejunum secondary to an annular adenocarcinoma of the jejunum. This is the first known report of abnormal Tc-99m pertechnetate accumulation in an adenocarcinoma of the small bowel.

Topics: Adenocarcinoma; Adult; Diagnosis, Differential; Humans; Jejunal Neoplasms; Male; Meckel Diverticulum; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Histopathology and scan findings of hot nodule on 99mTcO4- and/or 123I were correlated in 34 patients with thyroid nodules. In a series of 30 hot nodular lesions, 29 were either adenomas or benign nodules; however, one was proved follicular carcinomas histopathologically. And four patients were chronic thyroiditis without nodular lesions in the thyroid lobes, which were diagnosed pathologically and clinically. In 6 patients with palpable thyroid nodules, thyroid scans performed with both 99mTcO4- and 123I were compared. A discrepancy of the two types of scan existed in only one case. Subsequent surgery revealed no malignancy in this patient. From the results of 201T1 imaging of the thyroid gland in 30 patients with cold or hot nodules on either 99mTcO4- or 123I thyroid scanning, we found no distinct difference between the degrees of 201T1 malignant and nonmalignant tumors. It appears that 201T1 accumulation demonstrates only tumor volume and tumor cell viability in these subjects. From these results, it is confirmed that the functional heterogeneities exist in thyroid adenoma tissues as well as in thyroid cancerous tissues. Therefore, the development of the reliable techniques used to distinguish a benign from malignant lesion is indispensable.

Topics: Adenocarcinoma; Adenoma; Adult; Aged; Aged, 80 and over; Female; Goiter, Nodular; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms; Thyroiditis

To evaluate the use of Tc-99m pertechnetate whole body scanning for the detection of metastases of differentiated thyroid carcinoma, the authors performed sequential Tc-99m pertechnetate and I-131 scans in five patients with known or suspected metastatic thyroid cancer. All five patients had abnormal I-131 uptake, but only two patients had abnormal Tc-99m pertechnetate uptake. A total of 33 abnormal foci were located with I-131; Tc-99m pertechnetate detected only 3 of these foci, and did not demonstrate any foci that were not apparent with I-131. Despite the theoretical advantages of Tc-99m pertechnetate, it cannot be recommended as a substitute for I-131 for locating thyroid cancer metastases.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Whole-Body Counting

Neck metastases secondary to thyroid cancer are rarely visualized scintigraphically in the presence of a functioning thyroid gland. We present a patient with cervical lymph node metastases that take up 99mTc pertechnetate in the presence of hyperfunctioning thyroid tissue and discuss the pathophysiology of this phenomenon.

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Gland; Thyroid Neoplasms

The monoclonal antibody PR1A3 against a normal colonic columnar cell surface antigen has been labelled with 99mTc and used for imaging colorectal cancer. High uptake in undifferentiated cancer is seen. The tumour to mucosa ratio was up to 63:1 and the percentage of the injected activity in the tumour up to 1.7 X 10(-2%)g-1. As 99mTc is continuously available in a Nuclear Medicine Department, on receipt of a request the study may be completed within 24 h enabling radioimmunoscintigraphy to be used routinely in the management of patients with colorectal cancer.

Topics: Adenocarcinoma; Antibodies, Monoclonal; Colorectal Neoplasms; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

Over 3 years, a prospective comparison was made between Tc-99m pertechnetate and I-131 for the detection of residual and metastatic tissue in the follow-up of patients with cancer of the thyroid. All patients stopped thyroid medication for a minimum of 4 weeks. All patients had imaging done first with Tc-99m pertechnetate followed within a maximum of 2 weeks by I-131. The study included 66 patients in whom 81 studies were done with both Tc-99m and I-131. The results showed that 27 studies were positive with both Tc-99m and I-131 (true positive): 19 in the thyroid bed, four lymph nodes, two bony metastases, and two pulmonary metastases. Five patients had negative results with Tc-99m and positive results with I-131 (false negative): three in the thyroid bed, one lymph node metastasis, and one pulmonary metastasis. Only one case was positive with Tc-99m in the neck but negative with I-131 (false positive). The remaining 48 studies were negative both with Tc-99m and I-131 (true negative). Considering I-131 imaging as the standard procedure, Tc-99m had a sensitivity of 87%, specificity of 97%, and accuracy of 92.5% for the detection of residual or metastatic functioning thyroid tissue.

Topics: Adenocarcinoma; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Neoplasm Metastasis; Neoplasm Recurrence, Local; Prospective Studies; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Carcinoma of the thyroid is usually delineated as a cold defect on images with radioiodine and Tc-99m per-technetate. However, several cases that showed an accumulation of Tc-99m pertechnetate in thyroid carcinoma or in their metastases, but did not show any accumulation of radioiodine, have been reported. This paper presents a rare case of an advanced follicular adenocarcinoma of the thyroid that accumulated both Tc-99m pertechnetate and I-131. In this 41-year-old male patient, there were two primary foci in the thyroid; one occupied the whole left lobe with extension to the mediastinum and the other located in the lower part of the right lobe. In addition, there was a lymph node metastasis in the upper mediastinum adjacent to the left lobe. On images with both I-131 and Tc-99m pertechnetate, the tumor in the left lobe and the metastatic lymph node were delineated, but the tumor in the right lobe was not. Accumulation of Tc-99m pertechnetate in the lower part of the tumor of the left lobe was more distinct than that of I-131. Therefore, it is considered that despite similar histologic findings the trapping ability of the cancerous tissue differed from area to area.

Topics: Adenocarcinoma; Adult; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

During a 10-year period, 63 patients with thyroid malignancies were imaged with 99mTc-pertechnetate (99mTc) and 9 of them also underwent imaging with 131I. To evaluate 99mTc in the detection of thyroid carcinoma, the scans were blindly analyzed and compared with the reports of surgeons and pathologists. The carcinomas were located in hypoactive nodules in 60 cases, there were cold nodules in the three remaining thyroids, but accurate localization of the carcinomas was not possible, however, it seemed that only one of these could have been situated either in a hot or a cold nodule. The 99mTc and 131I images were almost the same. The most common carcinomas were papillary (46%) and follicular (38%) forms. More than one hypoactive nodule was detected in 48% of patients, two or more carcinoma nodules were noted in 17%, and multinodular goitre in 29% of patients. Our study confirms the usefulness of 99mTc in carcinoma detection, we suggest that reimaging of all the functioning nodules on the 99mTc scan with radioiodine, as recommended by many authors, is neither necessary nor justifiable.

Topics: Adenocarcinoma; Carcinoma; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Topics: Adenocarcinoma; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

Radionuclide imaging with both Tc-99m sodium pertechnetate and Tl-201 chloride was studied in 152 patients with thyroid nodules. Ultrasonography also was performed in 81 of those patients. Tc-99m sodium pertechnetate scans demonstrated nodules in 69.7% of 78 differentiated thyroid carcinomas (DC) and 72.2% of 54 thyroid adenomas (Ad). Tl-201 chloride was accumulated in 73.7% of DC and 53.6% of Ad. By combining the Tc-99m sodium pertechnetate and Tl-201 chloride scans, the detectability of the nodules was increased to 90.8% for DC and 88.9% for Ad, respectively. The Tc-99m sodium pertechnetate scans showed better visualization of cystic lesions than did the Tl-201 chloride imaging. The Tl-201 chloride images clearly demonstrated intrathoracic tumor invasions in six cases of carcinoma and two cases of Ad. The Tl-201 chloride scan was also of value in detecting regional lymph node involvement and the recurrence and metastasis after thyroidectomy. The detectability of space-occupying lesions by ultrasonography was 96.3% in 81 patients with thyroid nodules. Ultrasonography differentiated well between solid and cystic lesions. The presence and extent of nodular lesions were detected with radionuclide imaging and ultrasonography in 98.8% of patients. Radionuclide imaging combined with ultrasonography provides a rapid, convenient, and useful method for the localization and visualization of thyroid tumors.

Topics: Adenocarcinoma; Adenoma; Adolescent; Adult; Aged; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thallium; Thyroid Neoplasms; Ultrasonography

Metastatic carcinoma to the thyroid gland rarely is encountered in clinical practice; however, autopsy series have shown that it is not a rare occurrence. A case of adenocarcinoma of the colon with metastases to the thyroid is reported. A review of the literature reveals that melanoma, breast, renal, and lung carcinomas are the most frequent tumors to metastasize to the thyroid. Metastatic disease must be considered in the differential diagnosis of cold nodules on radionuclide thyroid scans, particularly in patients with a known primary.

Topics: Adenocarcinoma; Adenoma; Colonic Neoplasms; Female; Humans; Iodine Radioisotopes; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Blood pool and flow were studied in transplanted adenocarcinomas on the legs of mice. The animals' red blood cells were labelled in vivo by consecutive injections of a stannous compound and 99mTc-pertechnetate. The distribution of radioactivity was then recorded continuously with a gamma camera. This method allows prolonged and repeated estimations of blood supply to undisturbed tumours in conscious mice. It was found that in small tumours (under 1 ml) circulating blood pool was usually high, often 2 or 3 times that in normal leg tissues. In tumours bigger than 1 ml blood pool per unit volume tended to be lower but was still about 1.5 times the normal tissue level. This relatively large blood volume would seem to be outweighed by a very slow rate of flow. Even in the small tumours blood perfusion was greatly reduced compared to that in the normal leg. The blood pool results here provide no evidence that in tumours larger than 1 ml blood supply decreased progressively with growth.

Topics: Adenocarcinoma; Animals; Blood Volume; Erythrocytes; Hindlimb; Mice; Mice, Inbred Strains; Neoplasm Transplantation; Radionuclide Imaging; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Time Factors

A young man with papillary-follicular thyroid carcinoma demonstrated clear visualization of cervical metastases from thyroid cancer on Tc-99m pertechnetate scintigraphy while exhibiting a palpably and scintigraphically normal thyroid gland. This is a very rare occurrence which demonstrates that Tc-99m pertechnetate scintigraphy is capable of detecting cervical metastases from thyroid carcinoma before the appearance of palpable thyroid nodules or defects on scintigraphy.

Topics: Adenocarcinoma; Adult; Head and Neck Neoplasms; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms

Only 15% to 25% of cold nodules on conventional static thyroid scans are malignant. Radionuclide angiography of the thyroid and conventional static scans using sodium pertechnetate Tc 99m were performed on 114 patients who underwent thyroid surgery within a five-year period. The combined use of radionuclide angiography and conventional static scans increased the specificity for the diagnosis of thyroid carcinoma from 42% to 79% over static scans alone. The incidence of carcinoma in solitary cold nodules in our population was increased from 26% on static scans to 60% if the lesion was hypervascular on radionuclide angiography. Eighty-seven percent of hypervascular solitary cold nodules were neoplasms (carcinomas and adenomas). Hypervascularity as demonstrated by radionuclide angiography is predictive of thyroid neoplasia. The finding of a hypervascular, solitary cold nodule makes a recommendation for surgery predictive and reasonable.

Topics: Adenocarcinoma; Adenoma; Carcinoma; Carcinoma, Papillary; Diagnosis, Differential; Graves Disease; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms

A 23-year-old male presented with occult gastrointestinal bleeding and iron deficiency anemia. A Tc-99m pertechnetate abdominal scan was positive and surgery revealed an adenocarcinoma of the cecum. No Meckel's diverticulum was identified. This is the first reported association of an abnormal Tc-99m pertechnetate scan in adenocarcinoma. Carcinoma of the right colon should be considered in any patient with a positive pertechnetate scan for Meckel's diverticulum and suggestive clinical features.

Topics: Adenocarcinoma; Adult; Cecal Neoplasms; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m

A 70-yr-old woman presented with hyperthyroidism and metastatic follicular carcinoma of the thyroid. The blood level of thyroid stimulating immunoglobulin (TSIg) was elevated. A total thyroidectomy was performed. One month later she remained hyperthyroid. Three weeks after therapy with 218 mCi of I-131 sodium iodide, the patient was euthyroid. Six months after the initial radioiodide therapy, she was again hyperthyroid and was given a second oral treatment dose of I-131 (220 mCi). Five months later, the patient had again become euthyroid. It is likely that initially the woman's metastases were producing sufficient hormone to render her hyperthyroid. After thyroidectomy and two large doses of radioiodide, she has remained euthyroid without having to take exogenous hormone. The blood level of TSIg had become undetectable. Based on this finding, we offer a tentative classification of the causes of hyperthyroidism in patients with thyroid carcinoma.

Topics: Adenocarcinoma; Aged; Female; Humans; Hyperthyroidism; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Iodine Radioisotopes; Paraneoplastic Endocrine Syndromes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Thyroid Neoplasms; Thyroidectomy

Topics: Adenocarcinoma; Adult; Carcinoma, Papillary; Female; Humans; Lymphatic Metastasis; Sodium Pertechnetate Tc 99m; Technetium; Thyroglobulin; Thyroid Neoplasms

A radiolabelled monoclonal antibody was injected intravenously into two patients with disseminated carcinoma of the colon and serial scintigrams were then obtained on three consecutive days. In addition to the "specific" antibody image, blood pool and conventional liver scans were also obtained. After computer-based subtraction discrete hepatic metastases could be demonstrated in both patients, while in the second patient, the primary colonic tumour was also visualised for the first time. The study demonstrates the specific localisation of primary and secondary carcinoma of the colon with a radiolabelled monoclonal anti-tumour antibody and offers an improved method of specifically detecting tumours in man.

Topics: Adenocarcinoma; Adult; Antibodies, Monoclonal; Colonic Neoplasms; Humans; Iodine Radioisotopes; Liver Neoplasms; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Subtraction Technique; Technetium

An 11-year-old dog was diagnosed as having concurrent unilateral follicular thyroid carcinoma and hypothyroidism. Radioisotope imaging with technetium 99m as sodium pertechnatate identified the extent of thyroid tissue involvement. A combination of surgical resection and hormonal supplementation resulted in a favorable clinical response.

Topics: Adenocarcinoma; Animals; Dog Diseases; Dogs; Hypothyroidism; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium; Thyroid Neoplasms

Topics: Adenocarcinoma; Brain; Brain Neoplasms; Cerebrovascular Disorders; Humans; Meningeal Neoplasms; Meningioma; Radioisotopes; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium