technetium-tc-99m-medronate and Thyroid-Neoplasms

Among various imaging modalities used for the diagnosis of thyroid diseases, ultrasonography is the most sensitive and economical method to visualize anatomic detail and structural relations. Scintigraphy using 123I or 99mTc gives critical information about thyroid cell function and makes it possible to differentiate the causes of thyrotoxicosis. Tumor scintigraphy using 201T1, 67Ga, 131I-metaiodobenzyl guanidine or 99mTc(V)-dimercaptosuccinic acid is useful for the characterization of nodules. Recently introduced magnetic resonance imaging appears promising in demonstrating pseudocapsules around tumors and capsular invasion.

Topics: Humans; Magnetic Resonance Imaging; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Diseases; Thyroid Gland; Thyroid Neoplasms; Tomography, X-Ray Computed; Ultrasonography

Radionuclide bone scanning (RNB) is considered to be the most practical screening technique for assessing the entire skeleton for skeletal metastases. However, RNB has been shown to be of lower sensitivity than MRI and CT in detecting osteolytic metastases. A prospective study was designed to evaluate the accuracy of planar RNB versus tomographic bone imaging with 18F-labeled NaF and PET (18F PET) in detecting osteolytic and osteoblastic metastases and its dependency on their anatomic localization.. Forty-four patients with known prostate, lung or thyroid carcinoma were examined with both planar RNB and 18F PET. A panel of reference methods including MRI of the spine, 1311 scintigraphy, conventional radiography and spiral CT was used as the gold standard. RNB and 18F PET were compared by a lesion-by-lesion analysis using a five-point score for receiver operating characteristic (ROC) curve analysis.. 18F PET showed 96 metastases (67 of prostate carcinoma and 29 of lung or thyroid cancer), whereas RNB revealed 46 metastases (33 of prostate carcinoma and 13 of lung or thyroid cancer). All lesions found with RNB were also detected with 18F PET. Compared with 18F PET and the reference methods, RNB had a sensitivity of 82.8% in detecting malignant and benign osseous lesions in the skull, thorax and extremities and a sensitivity of 40% in the spine and pelvis. The area under the ROC curve was 0.99 for 18F PET and 0.64 for RNB.. 18F PET is more sensitive than RNB in detecting osseous lesions. With RNB, sensitivity in detecting osseous metastases is highly dependent on anatomic localization of these lesions, whereas detection rates of osteoblastic and osteolytic metastases are similar. Higher detection rates and more accurate differentiation between benign and malignant lesions with 18F PET suggest the use of 18F PET when possible.

Topics: Bone Neoplasms; False Negative Reactions; Fluorine Radioisotopes; Humans; Lung Neoplasms; Magnetic Resonance Imaging; Male; Prospective Studies; Prostatic Neoplasms; Radiopharmaceuticals; Sodium Fluoride; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

This study was carried out in order to investigate the possible detrimental effects on bone of levothyroxine (l-T4) suppressive therapy in female patients who had undergone surgery for differentiated thyroid cancer (DTC). Twenty female (14 premenopausal and 6 postmenopausal) patients receiving l-T4 suppressive therapy for DTC were studied. The sample was selected in such a way as to avoid factors influencing bone metabolism other than l-T4. All patients were monitored by sensitive thyroid-stimulating hormone, free triiodothyronine and free thyroxine assays throughout the follow-up. Nineteen healthy (12 premenopausal and 7 postmenopausal) matched women served as controls. In all subjects bone turnover was evaluated by the measurement of global skeletal uptake of technetium-99m methylene diphosphonate (GSU); bone mineral density (BMD) was measured by quantitative computed tomography at the lumbar spine (LS) and by dual-energy X-ray absorptiometry both at the LS and at three femoral sites: the femoral neck, Ward's triangle and the greater trochanter. No significant difference was found in either GSU or BMD between patients (treated for an average period of 68 months) and controls in the whole sample or in any subgroup. Furthermore, no correlations were found between either GSU or BMD and the duration of therapy, daily doses of l-T4 or results of thyroid function tests. Our data show that carefully monitored l-T4 therapy does not influence skeletal turnover (directly reflected by GSU) or the bone density of the spine and femur.

Topics: Absorptiometry, Photon; Adult; Biomarkers; Bone and Bones; Bone Density; Female; Follow-Up Studies; Humans; Middle Aged; Neoplasm Recurrence, Local; Postmenopause; Premenopause; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Function Tests; Thyroid Neoplasms; Thyroxine

Detectability of bone metastases from differentiated thyroid carcinoma by technetium-99m hydroxymethylene diphosphonate ([99m]Tc-HMDP) bone scan is considered to be poor. Thallium-201 (201Tl) is also widely used for detecting metastatic lesions. Our present study was aimed at the evaluation of the combined use of (99m)Tc-HMDP and 201Tl imaging in successful detection of bone metastases from differentiated thyroid carcinoma. Twenty-seven thyroidectomized thyroid cancer patients (19 females, 8 males; 12 papillary type, 15 follicular type) with 77 bone lesions were included in this retrospective study. All of these patients received ablative doses of radioiodine. Thyroidal origin of the lesions was proved by positive iodine-131 (131I) uptake. In 131I-negative lesions, histological proof or absence of tumor markers other than thyroglobulin was considered when computed tomography (CT) and/or magnetic resonance imaging (MRI) suggested metastatic nature of the lesions. Of the 77 lesions, 58 (75.3%) were positive and 19 were negative in the (99m)Tc-HMDP bone scintigraphy, whereas 53 lesions (68.9%) could be detected by 201Tl scintigraphy. However, within the 19 (99m)Tc-HMDP-negative lesions, 14 showed abnormal accumulation of 201Tl, and within the 24 201Tl negative lesions, 19 were positive in (99m)Tc-HMDP scan. This resulted in a combined sensitivity of 93.5%. Our present study concludes that combined (99m)Tc-HMDP and 201Tl imaging is a sensitive and effective method for detecting bone metastases from thyroid carcinoma.

Topics: Adenocarcinoma, Follicular; Adult; Aged; Bone Neoplasms; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thyroid Neoplasms

The aim was to track the exposure to radiation workers in six nuclear medicine examinations. A number of 180 patients were recruited and external exposure was measured. Patients had undergone cardiac stress and rest, bone scan, I-131 therapy, Gallium-67 and FDG PET/CT imaging. The average dose received due to cardiac stress and rest were 20.4 ± 5.0 and 16.0 ± 3.8 μSv per patient, respectively, whereas for bone scan, Ga-67, FDG and I-131 therapy, the average dose was 6.1 ± 2.5, 6.0 ± 1.4, 11.1 ± 2.2 and 4.1 ± 2.6 μSv per patient. The patient-to-staff dose coefficients were on average 0.051 ± 0.009, 0.042 ± 0.010, 0.034 ± 0.016, 0.039 ± 0.021, 0.052 ± 0.012, 0.094 ± 0.021 μSv m2/MBq h for stress, rest, bone, I-131, Ga-67 and FDG reported post-administration, respectively. Patient injection and setup for imaging represent a high percentage of the total dose received by staff. The information revealed is able to revise local measures, safety standards, and could help further in dose optimization and minimal exposure to occupationally exposed worker in nuclear medicine laboratories.

Topics: Fluorodeoxyglucose F18; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Middle Aged; Nuclear Medicine; Occupational Exposure; Positron-Emission Tomography; Prognosis; Radiation Dosage; Radiation Exposure; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Neoplasms

The classification of thyroid nodules in children is often difficult, especially in pretreated patients with metastatic disease. In osteosarcoma patients, Tc-MDP SPECT/CT is used for primary and follow-up staging. Bone and soft tissue metastases can be revealed because of Tc-MDP imaging of osteoid-producing metastases. We present Tc-MDP SPECT-CT, CT, and ultrasound images of a highly suspicious calcified thyroid lesion in a 17-year-old boy with osteosarcoma. High uptake in Tc-MDP SPECT-CT provides diagnosis of thyroid metastasis of osteosarcoma, which was proven by histopathology.

Topics: Adolescent; Bone Neoplasms; Humans; Male; Neoplasm Staging; Osteosarcoma; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Thyroid Neoplasms; Ultrasonography

We report a case of incidental uptake of 99mTc-methylene diphosphonate in the thyroid in a 62-year-old female with a history of breast cancer treated with quadrantectomy, chemotherapy and radiotherapy, who underwent total-body-bone scintigraphy during follow up. Planar scintigraphy was followed by neck SPECT-CT that demonstrated an area of increased tracer uptake in the neck at the left lobe of the thyroid. Neck ultrasonography showed a nodule corresponding to SPECT-CT finding and the ultrasound-guided fine needle aspiration documented the presence of papillary carcinoma. The patient underwent total thyroidectomy and ipsilateral lymphadenectomy; histological examination confirmed the presence of a papillary carcinoma and the patient underwent ablation therapy with iodine-131.

Topics: Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Middle Aged; Radiopharmaceuticals; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Medronate; Thyroid Neoplasms

The aim of this study was to compare the diagnostic and prognostic values of (99m)Tc-MDP-planar bone scintigraphy ((99m)Tc-MDP-BS), (131)I single-photon emission computed tomography/computed tomography ((131)I-SPECT/CT) and (18)F-fluorodeoxyglucose ((18)F-FDG)-PET/CT for the detection of bone metastases from differentiated thyroid cancer (DTC).. Eighty patients with DTC with suspected bone metastases from DTC were retrospectively analysed. All patients were examined with (99m)(99m)Tc-MDP-BS, (131)I-SPECT/CT and (18)F-FDG-PET/CT, with a maximum interval of 2 months between scans. The diagnostic performances of (99m)Tc-MDP-BS, (131)I-SPECT/CT and (99m)F-FDG-PET/CT were investigated and compared. Univariate and multivariate analyses were carried out to evaluate the effects of variables on the survival of patients.. Out of the 80 patients with 148 foci, 43 with 106 foci were diagnosed as being true positive for bone metastases from DTC. In patient-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of (99m)Tc-MDP-BS were 79.07, 83.78, 85.00, 77.50 and 81.25%, respectively; those of (131)I-SPECT/CT were 93.02, 97.30, 97.56, 92.31 and 95.00%, and those of (18)F-FDG-PET/CT were 86.05, 94.59, 94.87, 85.36 and 87.80%, respectively. In lesion-based analysis, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of (99m)Tc-MDP-BS were 72.64, 73.81, 87.50, 51.67 and 72.97%, respectively; those of (131)I-SPECT/CT were 92.45, 97.62, 98.99, 83.67 and 93.92%, and those of (18)F-FDG-PET/CT were 85.85, 88.10, 94.50, 71.15 and 86.49%, respectively. Comparing the receiver-operating characteristic area using the McNemar test, both (131)I-SPECT/CT and (18)F-FDG-PET/CT were found to be superior to (99m)Tc-MDP-BS for the detection of bone metastases from DTC in patient-based and lesion-based analyses (P<0.05). Patient-based analysis showed that there were no significant differences between (131)I-SPECT/CT and (18)F-FDG-PET/CT (P=0.087) but lesion-based analysis revealed that (131)I-SPECT/CT was superior to (18)F-FDG-PET/CT (P=0.002). For the association between these image patterns and the prognosis of DTC patients, (18)F-FDG positivity was the factor predicting a poor prognosis.. (131)I-SPECT/CT and (18)F-FDG-PET/CT demonstrated high diagnostic performance in detecting bone metastases from DTC. (99m)Tc-MDP-BS might be completely replaced by (131)I-SPECT/CT in combination with ((131)F-FDG-PET/CT in the management of DTC patients with bone metastases. (18)F-FDG-PET/CT positivity was an independent factor associated with poor prognosis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bone and Bones; Bone Neoplasms; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Iodine Radioisotopes; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Prognosis; Retrospective Studies; Sensitivity and Specificity; Survival Analysis; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, X-Ray Computed; Young Adult

A 30-year-old man diagnosed with follicular thyroid carcinoma treated previously with total thyroidectomy was referred to radioiodine treatment. Post-therapy scan performed 10 days after a 150 mCi 131NaI revealed radioiodine uptake in left temporal region. To elucidate the abnormal head uptake, Tc-99m MDP bone scan and head magnetic resonance image was performed. No anomalous uptake was observed in the bone scan. Head magnetic resonance image found a well-circumscribed lesion in temporal was compatible with a vascular malformation. Angioresonance confirmed the diagnosis of cavernous angioma, a benign vascular tumor.

Topics: Adult; Brain Neoplasms; Diagnosis, Differential; Hemangioma, Cavernous; Humans; Magnetic Resonance Imaging; Male; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Abnormalities, Multiple; Bone and Bones; Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Neoplasms

Interpretation of abnormal foci with high tracer uptake may require morphological correlation. Fusion of functional images obtained by single photon emission computed tomography (SPECT) and anatomical images obtained by computed tomography (CT) or magnetic resonance (RM) allows an integrated comprehension of complementary information.. To demonstrate that SPECT/CT fusion with external markers is useful in clinical practice to clarify the location and pathological meaning of questionable foci.. Thirty four pairs of images from separate equipments (31 SPECT/CT and 3 SPECT/RM) pertaining to 29 patients, were fused. Fifty one foci of abnormal tracer uptake of uncertain pathological meaning were analyzed. These were classified before and after the fusion as probably malignant or probably benign.. Seventy percent of patients had a differentiated thyroid carcinoma. The fusion localized 100% of foci. Nine percent had a normal and 26% an abnormal anatomy. Before fusion 82% of foci were classified as potentially malignant. This figure changed to 59% after the fusion (p <0.01). Therefore the suspicion of malignancy was presumptively confirmed in 72% of foci and fusion results would have reached a 27% of incremental diagnostic value in 14 cases that changed of category (11 with differentiated thyroid carcinoma, one with colorectal cancer, one with a nasal Ewing sarcoma and one with a brain tumor).. The fusion of SPECT and CT is useful in selected patients, specially those with differentiated thyroid carcinoma. The fusion of SPECT and RM is also feasible.

Topics: Adolescent; Adult; Aged; Carcinoma; Child; Child, Preschool; Female; Humans; Image Enhancement; Iodine Radioisotopes; Magnetic Resonance Imaging; Male; Middle Aged; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The lack of anatomical details in standard (131)Iodine whole body scanning ((131)I WBS) interferes with the proper localization of metastatic differentiated thyroid carcinoma (DTC) lesions. In addition, nearby or overlapping variable physiological distribution of (131)I may affect the specificity of (131)I uptake, giving indeterminate results. The aim of this study was to demonstrate the clinical usefulness of simultaneous co-registration of (99m)Tc MDP bone scanning as an anatomical landmark with (131)I scanning in the evaluation of metastatic DTC.. Twenty-five patients (16 females and 9 males, mean age +/- SD = 52 +/- 13 years) with metastatic DTC (17 papillary, 8 follicular), were included. Whole body scanning using a 256 x 1024 matrix and an 8 cm/min scan rate were obtained 48 hours after oral administration of 185-370 MBq 131I and 2 hours after IV administration of 185-370 MBq (99m)Tc MDP using a dual head gamma camera equipped with high energy parallel hole collimators. Occasionally, additional simultaneous co-registration of localised detailed images was also performed using a 256 x 256 matrix size. The two planar images were fused with optional fusion of SPECT images. The data from standard (131)I scanning and fused (131)I/ (99m)Tc-MDP scanning were separately assessed by two nuclear medicine physicians. Fusion images were considered to improve image interpretation in comparison with standard (131)I scanning when they provided better localization of lesions.. All lesions in the present study were validated by radiological images and clinical follow up for at least 12 months. Forty-eight metastatic lesions were confirmed as follows: 2 in the skull, 10 in the neck, 20 in the thorax, 12 in the pelvic-abdominal region and 4 in the extremities. Standard (131)I WBS showed 54 extra-thyroidal foci with 8 false positive lesions of which 2 were located in the scalp and 6 in the pelvic-abdominal region extra-skeleton (i.e. sensitivity 100%, specificity 86%). Out of the 48 validated lesions, 16 were indeterminately localized: 10 in the thorax (3 mediastinal nodal lesions, 5 vertebral lesions and 2 ribs) and 6 in the pelvic-abdominal region (2 upper sacral, 2 sacroiliac region and 2 ischial bone). Fusion images confirmed the precise localization of the pathological uptake in the validated 48 lesions (sensitivity 100%, specificity 100%). There were 2 (4%) indeterminate lesions in fused planar imaging that were clearly localized via fused SPECT images.. Fusion images using simultaneous co-registration of (131)I and (99m)Tc MDP scanning is a simple and feasible technique that improves the anatomically limited interpretation of scintigraphy using (131)I alone in patients with metastatic differentiated thyroid carcinoma. The diagnostic advantage of this technique seems to be more apparent in the thoracic and pelvic- abdominal regions in contrast to the neck and extremities.

Topics: Carcinoma; Female; Humans; Image Enhancement; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Subtraction Technique; Technetium Tc 99m Medronate; Thyroid Neoplasms; Whole Body Imaging

A 35-year-old man with a history of medullary carcinoma of the thyroid underwent a whole-body bone scan for chest wall pain. Extensive irregular radionuclide uptake was observed in hepatic metastases in both lobes, later confirmed on CT scan. A case of technetium-99m MDP uptake in hepatic metastases from medullary carcinoma of the thyroid is presented and the literature is reviewed.

Topics: Adult; Carcinoma, Medullary; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Neoplasms

(131)I whole-body scintigraphy is a highly sensitive method for the detection of differentiated thyroid tumours and metastases. However, a lack of anatomical landmarks and the physiological excretion of the tracer complicates the evaluation of the images. Therefore, we determined whether additional bone scintigraphy in combination with (131)I scintigraphy, simultaneously acquired via planar and tomographic techniques, positively contributes to the treatment plan in patients with non-conclusive (131)I images.. Twenty-one patients with differentiated thyroid cancer and known metastases or unclear findings in the (131)I whole-body scan underwent dual-isotope scintigraphy (DIS) within 2-7 days after application of 5000-8000 MBq (131)I. Dual-energy planar and tomographic data were acquired simultaneously and the results compared with other imaging modalities.. In 48% of the cases (10 of 21), DIS supplied important additional information that either altered the treatment plan or staging of the patients. In 28% (six of 21), DIS provided new information that was not known before, but did not change the staging of the patients. In five cases (24%), DIS did not add any new data regarding the extent of the disease.. The simultaneous acquisition of (131)I and (99m)Tc-methylene diphosphonate provides clear landmarks and facilitates the localization of functioning metastases from differentiated thyroid cancer as well as improves the fusion with morphological images. It can be performed easily and also transferred to other isotope combinations.

Topics: Adult; Aged; Drug Combinations; Female; Humans; Image Enhancement; Iodine Radioisotopes; Male; Middle Aged; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon

Diffuse metastatic visceral calcification is rare in breast cancer. We report on a 57-year-old woman with breast cancer and hypercalcemia who had diffuse metastatic visceral calcifications on lungs, myocardium, stomach, and thyroid on a (99m)Tc-methylene diphosphonate bone scan. Visceral calcifications were completely resolved 6 months after successful anticancer and zoledronic acid treatments. Bone scanning offers a useful diagnostic tool for both identifying visceral calcification and assessing the response to therapy in chemosensitive malignities with hypercalcemia such as breast cancer.

Topics: Antineoplastic Agents; Bone and Bones; Breast Neoplasms; Calcification, Physiologic; Calcium; Diphosphonates; Female; Heart Neoplasms; Humans; Imidazoles; Lung Neoplasms; Middle Aged; Neoplasm Metastasis; Stomach Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms; Time Factors; Zoledronic Acid

Mixed medullary-follicular thyroid carcinoma (MMFTC) is a rare tumor with a metastatic behavior that has not been fully appreciated. Scintigraphy and radioiodine entrapment propensity of its metastases remains largely undescribed. The authors present a case of MMFTC with widespread bone and soft-tissue metastases, where every known site of metastases concentrated radioiodine intensely. The patient responded well to radioiodine therapy. The report suggests that the tumor may have a propensity to metastasize to the skeleton, and the metastases retain the ability to accumulate radioiodine.

Topics: Adenocarcinoma, Follicular; Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Soft Tissue Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms

Poorly differentiated insular thyroid carcinoma is classified as a separate entity among other tumors of the thyroid gland. Its histological pattern and clinical course are regarded as intermediate between well-differentiated and anaplastic thyroid cancer. The authors report Tc-99m pertechnetate, Tc-99m MDP and radioiodine imaging features in a 33-year-old male patient with metastatic insular carcinoma of the thyroid. The extent of involvement was almost identical in all three studies. Insular carcinoma of the thyroid was shown by biopsy, and the patient received a cumulative dose of 14,800 MBq (400 mCi) radioactive I-131. Other radionuclide imaging agents are also reviewed.

Topics: Adult; Humans; Iodine Radioisotopes; Male; Neoplasm Metastasis; Palliative Care; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Medronate; Thyroid Neoplasms; Treatment Outcome

In a young patient with differentiated thyroid carcinoma (DTC), previously submitted to total thyroidectomy and I-131 therapy for ablation of thyroid remnant, a follow-up 1-131 diagnostic whole body scan (WBS) demonstrated four small abnormal I-131 uptake areas. Two of these were projected over the thoracic region and corresponded to lung nodules, as later demonstrated by lung computerized tomography (CT)-scan. The remaining two areas were found in the lumbar-pelvic region, but their precise location could not be determined. Standard bone Rx examination and bone scan were negative. After I-131 therapy, we simultaneously acquired a I-131 WBS and a Tc-99m oxidronate bone scan by setting a dual window on the gamma camera. Comparing the I-131 and bone images we were able to identify the 4th lumbar vertebra and right ilium as the bone segments to be studied by a radiological approach. Eventually, the thin slice CT-scan demonstrated the presence of two small osteolytic lesions in these areas. In conclusion, the simultaneous acquisition of images both from I-131 and a bone-seeking agent may be useful to locate functioning bone metastases from DTC.

Topics: Adult; Carcinoma, Papillary; Humans; Iodine Radioisotopes; Male; Radionuclide Imaging; Radiopharmaceuticals; Spinal Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms; Tomography, X-Ray Computed

Topics: Carcinoma; Female; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Skull; Skull Neoplasms; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thyroid Neoplasms; Tomography, X-Ray Computed; Ultrasonography

Topics: Bone Marrow Neoplasms; Carcinoma, Medullary; Female; Humans; Middle Aged; Neoplasm Invasiveness; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate; Thyroid Neoplasms

Superimposition of SPECT and computed tomography (CT) slices from the thoracoabdominal region was achieved without the use of external markers for 14 studies in 13 patients with endocrine carcinoma. Technical feasibility and clinical validation of this retrospective fusion method were assessed.. Patients had a history of thyroid cancer or of carcinoid tumor. To detect tumor sites, CT scan and dual-isotope tomoscintigraphy were performed, with 99mTc-hydroxymethylene diphosphonate for bone scintigraphy and with 111In-pentetreotide, 131I or 131I-metaiodobenzylguanidine for tumor scintigraphy (TS). A superimposition method previously developed for the pelvic region was adapted to the nonrigid thoraco-abdominal region. CT-bone scintigraphy and CT-TS superimposed images were obtained. Clinical validation of the information obtained from the superimposed images was obtained from surgery or follow-up imaging studies performed after clinical evolution of the disease process.. Reliable and reproducible registration was achieved in all patients. CT-TS superimposed images produced accurate localization of abnormal TS foci. Accuracy was limited primarily by variable relative displacements of the thoracoabdominal organs. For 10 sites in 8 patients, localization and/or characterization obtained from CT-TS images was confirmed by a reference technique. Superimposition enabled the localization of tumor sites that otherwise could not have been suspected from CT alone and allowed the characterization of CT suspicious masses and the confirmation of CT positive sites. Nonspecific tumor TS uptake sites were also localized.. With standard CT and dual-isotope SPECT acquisitions, SPECT-CT fusion is feasible in the thoracoabdominal region without the use of external markers. Fused images were validated in 8 patients for 10 sites. The use of this technique could probably improve the management and care of patients with endocrine carcinoma.

Topics: 3-Iodobenzylguanidine; Abdominal Neoplasms; Carcinoid Tumor; Carcinoma, Medullary; Feasibility Studies; Humans; Image Processing, Computer-Assisted; Indium Radioisotopes; Iodine Radioisotopes; Iodobenzenes; Octreotide; Pentetic Acid; Radiopharmaceuticals; Reproducibility of Results; Retrospective Studies; Technetium Tc 99m Medronate; Thoracic Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The bone-seeking radiopharmaceutical Sr-89 has been used as a palliative treatment for patients with bone pain caused by bone metastases. The authors report the results of nine patients (three with prostate cancer, four with breast cancer, one with thyroid cancer, and one with lung cancer) who underwent therapy with Sr-89 chloride for painful bone metastases, and evaluate Sr-89 imaging with bremsstrahlung. Two levels of dosage (1.5 and 2.2 MBq/kg) were used. Sr-89 imaging was performed in seven patients 1 week after injection. Abnormal uptake was seen in all and was consistent with the results of Tc-99m HMDP imaging. Six patients were assessed at 3 months and three patients toward the time they were terminal; 78% (seven of nine) derived some benefit. Two patients had a favorable clinical response and showed improvement on Tc-99m HMDP imaging.

Topics: Adult; Aged; Bone and Bones; Bone Neoplasms; Breast Neoplasms; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Pain; Palliative Care; Prostatic Neoplasms; Radionuclide Imaging; Radiopharmaceuticals; Radiotherapy Dosage; Remission Induction; Strontium Radioisotopes; Technetium Tc 99m Medronate; Terminal Care; Thyroid Neoplasms

We report a case of metastatic insular carcinoma of the thyroid evaluated with 201TI, 99mTc-MIBI, 99mTc-(V)DMSA, 99mTc-MDP and 131I whole-body scans, which were obtained after total thyroidectomy. For the majority of lesions detected in the skeleton and soft tissue, 131I images were generally available, although most were visualized easier with 99mTc-(V)DMSA. Technetium-99m-MDP images were considered better than 99mTc-(V)DMSA images in showing bone lesions but not soft-tissue lesions. Both 201TI and 99mTc-MIBI scans provided sufficient advantage to exhibit neck and mediastinal metastases, but they did not surpass 99mTc-(V)DMSA in detecting abdominal or bony lesions. In this patient with various metastases from insular carcinoma of the thyroid, 99mTc-(V)DMSA seemed to be the tracer of choice for whole-body imaging.

Topics: Bone Neoplasms; Carcinoma, Medullary; Female; Humans; Iodine Radioisotopes; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Soft Tissue Neoplasms; Succimer; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Technetium Tc 99m Sestamibi; Thallium Radioisotopes; Thyroid Neoplasms

We present 131I scintigraphic findings in a patient with insular carcinoma of the thyroid showing diffuse abnormal uptake throughout the skeleton. The scintigraphy closely resembled the pattern of [131I]MIBG distribution in children with bone marrow metastases of neuroblastoma. The extent of involvement was underestimated by bone scintigraphy and radiography. Insular carcinoma of the thyroid in the bone marrow was subsequently demonstrated by biopsy. The patient was treated with 242 mCi 131I given in two courses, which led to severe myelosuppression and died as a result of progressive disease and severe pancytopenia 10 mo after initial therapy.

Topics: Biopsy; Bone and Bones; Bone Marrow; Bone Marrow Neoplasms; Carcinoma; Female; Humans; Iodine Radioisotopes; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Adult; Carcinoma, Papillary; Female; Humans; Iodine Radioisotopes; Mediastinum; Technetium Tc 99m Medronate; Thymus Gland; Thymus Neoplasms; Thyroid Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Female; Humans; Middle Aged; Radionuclide Imaging; Skull Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms

I-131 whole-body imaging may show characteristic findings in functioning, metastatic differentiated thyroid carcinoma. Nonthyroidal tumor uptake of I-131 is rare, but may mislead the physician to inappropriate treatment. A case is reported of a 59-year-old woman with papillary thyroid carcinoma who demonstrated strong uptake of I-131 in an abdominal cystic neurilemoma. Her serum thyroglobulin concentration at that time was low, at 3.35 ng/ml. Although the concentrating mechanism of I-131 was not clear, several clues pointed to the possibilities of nonthyroidal tumor uptake: 1) faster clearing of radioactivity than usual thyroid tissue, 2) persistent low serum thyroglobulin concentration, and 3) the presence of a cystic component in the nonthyroidal tumor.

Topics: Abdominal Neoplasms; Carcinoma, Papillary; Diagnosis, Differential; False Positive Reactions; Female; Humans; Iodine Radioisotopes; Middle Aged; Neoplasms, Second Primary; Neurilemmoma; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroglobulin; Thyroid Neoplasms

Insular carcinoma of the thyroid appears to represent an entity situated morphologically and biologically in an intermediate position between the well-differentiated and undifferentiated (anaplastic) tumors. The retention of I-131 concentrating ability by this variant, unlike anaplastic, is very encouraging and amenable to detection and therapy by radioiodine after initial aggressive surgery. A 46-year-old man with a histologic label of anaplastic thyroid carcinoma has had an unusually prolonged disease-free survival and histopathologic review confirmed insular carcinoma. Postoperative radioiodine evaluation revealed avid concentration of tracer in the thyroid bed. Thus, it is possible to ablate with radioiodine. The insular carcinoma should be considered as a distinct clinicopathologic entity and widespread awareness of this variant of tumor may help pathologists, surgeons, and nuclear medicine practitioners to aggressively treat the condition after initial diagnosis.

Topics: Carcinoma; Humans; Iodine Radioisotopes; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

Iodine-131 is uniquely able to demonstrate iodine uptake of differentiated thyroid carcinoma (DTC), but precise localization may be difficult, especially in the thorax, due to the quality of image resolution with 131I and the lack of anatomical landmarks. When bone metastases do not show radioiodine uptake bone scintigraphy can be used to detect them. We studied two groups of patients. In group 1, 15 patients with known bone metastases of DTC were treated with 3.7 GBq 131I. After 4 or 5 days, technetium-99m hydroxymethylene diphosphonate (HMDP; 740 MBq) was injected and a whole-body scan with simultaneous acquisition of 131I and 99mTc-HMDP images was carried out using a large field of view gamma camera fitted with a high-energy collimator. Technetium uptake was abnormal in 47 of 63 localizations, being increased in 29 foci, decreased in 7 and heterogeneous in 11. The superimposition of 131I and 99mTc-HMDP scans permitted an accurate localization in 80% of spine metastases and in 46% of osseous thoracic localizations, even in the presence of lung metastases. In group 2, 9 patients, who had bone pain, neurological signs or elevated serum thyroglobulin, had DTC bone metastases without iodine uptake. They received a diagnostic dose of 99mTc-HMDP 3h prior to scintigraphy with a large field of view gamma camera fitted with a low-energy collimator. Technetium uptake was abnormal in 37 of 38 localizations, being increased in 34 foci and decreased in 3. One false-negative was found in a skull metastasis. In both groups of patients, 99mTc-HMDP scans were useful.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adenocarcinoma, Follicular; Adult; Aged; Bone Neoplasms; Carcinoma, Papillary; Female; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

A 30-yr-old woman with previously resected papillary thyroid carcinoma was found to have a pelvic lesion which concentrated radioiodine. By performing simultaneous 131I whole-body and 99mTc-methylene diphosphonate bone scans, we found the lesion to be in soft tissue between the sacrum and bladder. Radioiodine therapy was postponed so that the lesion, a benign teratoma of the rectal wall, could be surgically removed. Prior to laparotomy, the patient received a second tracer dose of 131I so that the lesion could be located at surgery with a hand-held gamma detector. A postoperative whole-body 131I scan confirmed that the lesion had been removed, thus reducing the absorbed radiation that would have been received by the ovaries during radioiodine therapy. Although the lesion contained both thyroid and gastric epithelium, accumulated 131I was limited to the area with thyroid follicles.

Topics: Adult; Bone and Bones; Carcinoma, Papillary; Dermoid Cyst; Female; Humans; Intraoperative Care; Iodine Radioisotopes; Neoplasms, Multiple Primary; Radionuclide Imaging; Rectal Neoplasms; Sigmoid Neoplasms; Technetium Tc 99m Medronate; Thyroid Neoplasms; Thyroidectomy

Topics: Adenocarcinoma; Bone Neoplasms; Humans; Male; Middle Aged; Pelvic Bones; Radionuclide Imaging; Technetium Tc 99m Medronate; Thallium Radioisotopes; Thyroid Neoplasms

A 99mTc-MDP scan was done on a patient with liver metastases from a medullary thyroid carcinoma who, in addition, had a familial history of multiple endocrine neoplasm, type 2. The scan revealed accumulation in several areas of calcified liver metastases.

Topics: Adult; Calcinosis; Carcinoma; Female; Humans; Liver Neoplasms; Radionuclide Imaging; Technetium Tc 99m Medronate; Thyroid Neoplasms

Nine patients with histologically proven medullary carcinoma of the thyroid (MCT) were imaged using pentavalent [99mTc]dimercaptosuccinic acid [(V)DMSA], [131I] metaiodobenzylguanidine (MIBG) and [99mTc]methylene diphosphonate (MDP). Technetium-99m (V)DMSA demonstrated most of the tumor sites in eight patients with proven metastases, with an overall sensitivity of 95% in lesion detection. Iodine-131 MIBG showed definite uptake in some of the tumor sites in three of the nine patients imaged, with equivocal uptake seen in a further one patient, with sensitivity of only 11% for lesion detection. Technetium-99m MDP demonstrated bony metastases only, in four of the patients imaged yielding a sensitivity of 61%. Technetium-99m (V)DMSA has been demonstrated in this study to be a useful imaging agent in patients with MCT, showing uptake in significantly more lesions and with better imaging qualities than [131I]MIBG, and with the ability to detect soft tissue as well as bony metastases.

Topics: 3-Iodobenzylguanidine; Bone Neoplasms; Carcinoma; Humans; Iodine Radioisotopes; Iodobenzenes; Organometallic Compounds; Radionuclide Imaging; Succimer; Sulfhydryl Compounds; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Aged; Brain; Female; Gallium Radioisotopes; Humans; Lymphoma, Non-Hodgkin; Organotechnetium Compounds; Radionuclide Imaging; Skull Neoplasms; Sugar Acids; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

A 37-year-old woman presented with a neck mass that proved to be medullary thyroid carcinoma by histologic and immunoperoxidase examinations. Serum calcitonin values were greatly elevated (over 100,000 pg/ml). There were widespread metastases in bone and liver. As the peripheral lesions showed only slight response to chemotherapy and local radiation therapy, potential use of radioiodine was studied. The bone lesions showed uptake of both Tc-99m MDP and radioiodide (I-131). Metastatic lesions were similar to the primary tumor in terms of histology, presence of calcitonin, and absence of thyroglobulin. Hence, the patient had a medullary thyroid carcinoma that took up radioiodide in its metastases. Two large oral doses of radioiodide (over 100 mCi each) did not significantly alter the serum calcitonin values, although there was a slight response in the activity of bone lesions. The whole body turnover of radioiodide was rapid (T 1/2 = 0.7 days). Upon oral administration of lithium carbonate, whole-body radioiodide turnover slowed slightly (T 1/2 = 1 day). If this effect were reflected in greater tumor retention of radioiodide (slower release), then agents that block radioiodide egress might have a role to play in therapy.

Topics: Adult; Bone Neoplasms; Calcitonin; Carcinoma; Combined Modality Therapy; Diphosphonates; Female; Humans; Iodine Radioisotopes; Lithium; Lithium Carbonate; Liver Neoplasms; Radionuclide Imaging; Sodium Iodide; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

A patient in whom metastatic medullary thyroid cancer was diagnosed underwent a scintigraphic examination using [131I]MIBG. Multiple hot lesions and diffuse hepatic uptake were noted corresponding to bone and liver metastases. Iodine-131 MIBG may prove to be useful for scintigraphic localization and for the treatment of medullary thyroid cancer as in pheochromocytoma and neuroblastoma.

Topics: 3-Iodobenzylguanidine; Diphosphonates; Female; Humans; Iodine Radioisotopes; Iodobenzenes; Liver Neoplasms; Middle Aged; Radionuclide Imaging; Spinal Neoplasms; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

A case of a "cold" lesion on sodium pertechnetate Tc 99m (99mTc) bone scan of the pelvis of a patient with an adenocarcinoma of the thyroid gland is reported. X-ray demonstrated an osteolytic metastasis, and biopsy revealed its origin to be a thyroid adenocarcinoma.

Topics: Adenocarcinoma; Aged; Bone Neoplasms; Diphosphonates; Female; Humans; Radionuclide Imaging; Sacrococcygeal Region; Technetium; Technetium Tc 99m Medronate; Thyroid Neoplasms

Topics: Adult; Carcinoma; Diphosphates; Diphosphonates; Etidronic Acid; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium; Technetium Tc 99m Medronate; Technetium Tc 99m Pyrophosphate; Thyroid Neoplasms